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A Word to the Wise on Drug Diversion
A Word to the Wise on Drug Diversion These us. attorneys report a conspiracy to illegally distribute controlled substances. by Michael M. Baylson , JD, Joan L. Markman, JD, and Sonia C. Jaipaul, JD
Milicia Pharmacy was a small neighborhood pharmacy located in a corner rowhouse in South Philadelphia. In July 1991 , the pharmacist owner, Angelo Milicia, was sentenced to nine years in prison for unlawfully distributing more than $5 million worth of controlled amphetamines, depressants, and codeine products in a conspiracy that lasted from 1982 through 1987. The court also required Milicia to forfeit more than $1.6 million profit-the largest pharmacy-related forfeiture in history-realized from his drug distribution. The Federal Drug Enforcement Administration (DEA) knew that throughout the 1980s Milicia Pharmacy was an excessive purchaser of frequently abused controlled substances and suspected that Milicia was distributing the drugs illegally. Among the drugs Milicia purchased excessively were the depressants Doriden, Valium, Talwin and Tuinal; the amphetamines Ritalin, Preludin, and Desoxyn; and codeine-based products such as Empirin #4 tablets and Tussionex, Ambenyl, and Bromanyl cough syrups. Several of the drugs were commonly abused in the Philadelphia area, and one combination-Doriden and a codeine product, known on the street as "fours and Dors" or "pancakes and syrup"-was the third leading cause of overdose deaths in Philadelphia from 1985 to 1988. The government's investigation revealed that employees of Milicia Pharmacy knowingly distributed these drugs to patrons who brought in bogus prescription orders-up to 100 at a time-in the names of different so-called "patients." In exchange for cash amounts of hundreds or thousands of dollars at a time, pharmacy employees provided these customers with large brown grocery bags full of prescription drugs. Milicia believed that because he had a prescription order for each dosage unit that he and his employees distributed, he could continue to distribute without interference from the authorities. If caught, he reasoned, he could claim he was merely dispensing a facially valid prescription order and he had no business questioning the doctors ' medical judgment to write these prescription orders. Milicia was wrong. Federal regulations impose a responsiAMERICAN PHARMACY
bility on pharmacists, separate from a physician's responsibility, to ensure that controlled substances are distributed only for legitimate medical purposes. The law provides that pharmacists cannot avoid this responsibility by closing their eyes to obviously illegitimate prescriptions. In Milicia's case, Linwood F. Tice, dean emeritus of the Philadelphia College of Pharmacy and Science, described for the court how the prescription orders Milicia accepted and dispensed were obviously illegitimate: • The same few physicians wrote more than 90% of the pharmacy's prescription orders, prescribing only controlled substances. • The prescription order amounts were always uniform. • Customers submitted several of these bogus prescriptions at a time in the names of different "patients. " The court agreed that Milicia purposely disregarded these clear indications that the prescription orders were illegitimate in sentencing Milicia to prison and forfeiture of profits. Several of Milicia's co-conspirators were prosecuted and convicted. The court sentenced three of Milicia's employees, including one licensed pharmaCist, to imprisonment and substantial fines. Five of Milicia's largest customers were also convicted. Moreover, two of the physicians whose bogus prescription orders Milicia processed received lengthy sentences and, in one case, a $1 million fine. The lesson of the Milicia Pharmacy case is that a professional license does not provide a refuge behind which pharmacists and physicians who divert pharmaceutical controlled substances may hide. Instead, courts regard diversion for what it is-drug dealing-and punish medical professionals as harshly as they punish any other drug dealers. Michael M. Baylson, JD, is a Us. attorney for the Eastern District ofPennsylvania, Philadelphia. Joan L. Markman, JD, and Sonia C. Jaipaul, JD, are assistant Us. attorneys for the district. The authors acknowledge the help of Linda A. Tracy in preparing this manuscript.
May 1992/430
Vol. NS32, No.5
Milicia Pharmacy was a small neighborhood pharmacy located in a corner rowhouse in South Philadelphia. In July 1991 , the pharmacist owner, Angelo Milicia, was sentenced to nine years in prison for unlawfully distributing more than $5 million worth of controlled amphetamines, depressants, and codeine products in a conspiracy that lasted from 1982 through 1987. The court also required Milicia to forfeit more than $1.6 million profit-the largest pharmacy-related forfeiture in history-realized from his drug distribution. The Federal Drug Enforcement Administration (DEA) knew that throughout the 1980s Milicia Pharmacy was an excessive purchaser of frequently abused controlled substances and suspected that Milicia was distributing the drugs illegally. Among the drugs Milicia purchased excessively were the depressants Doriden, Valium, Talwin and Tuinal; the amphetamines Ritalin, Preludin, and Desoxyn; and codeine-based products such as Empirin #4 tablets and Tussionex, Ambenyl, and Bromanyl cough syrups. Several of the drugs were commonly abused in the Philadelphia area, and one combination-Doriden and a codeine product, known on the street as "fours and Dors" or "pancakes and syrup"-was the third leading cause of overdose deaths in Philadelphia from 1985 to 1988. The government's investigation revealed that employees of Milicia Pharmacy knowingly distributed these drugs to patrons who brought in bogus prescription orders-up to 100 at a time-in the names of different so-called "patients." In exchange for cash amounts of hundreds or thousands of dollars at a time, pharmacy employees provided these customers with large brown grocery bags full of prescription drugs. Milicia believed that because he had a prescription order for each dosage unit that he and his employees distributed, he could continue to distribute without interference from the authorities. If caught, he reasoned, he could claim he was merely dispensing a facially valid prescription order and he had no business questioning the doctors ' medical judgment to write these prescription orders. Milicia was wrong. Federal regulations impose a responsiAMERICAN PHARMACY
bility on pharmacists, separate from a physician's responsibility, to ensure that controlled substances are distributed only for legitimate medical purposes. The law provides that pharmacists cannot avoid this responsibility by closing their eyes to obviously illegitimate prescriptions. In Milicia's case, Linwood F. Tice, dean emeritus of the Philadelphia College of Pharmacy and Science, described for the court how the prescription orders Milicia accepted and dispensed were obviously illegitimate: • The same few physicians wrote more than 90% of the pharmacy's prescription orders, prescribing only controlled substances. • The prescription order amounts were always uniform. • Customers submitted several of these bogus prescriptions at a time in the names of different "patients. " The court agreed that Milicia purposely disregarded these clear indications that the prescription orders were illegitimate in sentencing Milicia to prison and forfeiture of profits. Several of Milicia's co-conspirators were prosecuted and convicted. The court sentenced three of Milicia's employees, including one licensed pharmaCist, to imprisonment and substantial fines. Five of Milicia's largest customers were also convicted. Moreover, two of the physicians whose bogus prescription orders Milicia processed received lengthy sentences and, in one case, a $1 million fine. The lesson of the Milicia Pharmacy case is that a professional license does not provide a refuge behind which pharmacists and physicians who divert pharmaceutical controlled substances may hide. Instead, courts regard diversion for what it is-drug dealing-and punish medical professionals as harshly as they punish any other drug dealers. Michael M. Baylson, JD, is a Us. attorney for the Eastern District ofPennsylvania, Philadelphia. Joan L. Markman, JD, and Sonia C. Jaipaul, JD, are assistant Us. attorneys for the district. The authors acknowledge the help of Linda A. Tracy in preparing this manuscript.
May 1992/430
Vol. NS32, No.5