While the community continues to be concerned about the prescription drug abuse statistics in the area, the local Drug Task Force has conducted three meetings in the past four months. The formation of the task force is a response to what’s being called “an epidemic of drug addiction, overdose death, crime and social disruption.” Additionally, Scioto County is listed among the top 10 in the nation in illegal trafficking of prescription drugs, and drug overdose is now the leading cause of accidental death in Scioto County.
According to the Scioto County Prescription Drug Action Team, Scioto County has the largest concentration of pain clinics per capita of all of Ohio’s counties, and a recent Board of Pharmacy report indicated southern Ohio prescribers wrote prescriptions for 20 million more oxycodone and hydrocodone pills than a similar area in northern Ohio.
When the topic of pain clinics comes up, one name is always mentioned first. That name is Dr. Margy Temponeras, who operates the Unique Pain Management Clinic on Center Street in Wheelersburg. Recently, the Portsmouth Daily Times was granted unprecedented access to the clinic and the people who operate it.
Temponeras pondered the question as to why her name is always mentioned when people talk about pain clinic doctors as pill dealers.
“I don’t have a good answer for that,” Temponeras said. “I’m not a dealer. I’m a physician. I’m board certified. I belong to three pain management boards, and I think that’s unusual for this area. I can tell you, I have the most patients. I’ve been doing it the longest, and I have a referral base of all of the counties and Huntington (West Virginia), as well as upper Kentucky and lower Ohio, and that makes them all come here, because those counties have all consistently, one by one, dropped out of prescribing pain medicine. The physicians that refer here have a relationship with me. They know how I operate, and that is the only place they want to entrust their patients to.
“I can’t help it that I have to treat the worst of the worst. You can’t discriminate against a diabetic. One takes a pill. One takes insulin. You can’t make fun of someone because they have more pain than someone else. So I don’t have a good answer. I can just say I have been here the longest.”
Dr. Terry Johnson, Scioto County coroner and program director of the Family Practice Residency at Southern Ohio Medical Center, said every physician involved in patient care knows that every patient is unique.
“The personal physician has a broad spectrum of therapies for pain management that can be applied before resorting to use of narcotic analgesics. To help in making an accurate diagnosis and to set the stage for optimal treatment, this is often the point that the prudent primary care doctor will seek help through appropriate consultations with specialists such as neurosurgeons, physiatrists, and legitimate pain specialists.”
Everyone who comes to Temponeras’ office must come by way of referral from other physicians. In other words, you can’t just walk in off the street.
“They have to be referred by a doctor. No walk-ins,” employee Darrell Leadingham said.
Leadingham said clients fill out an application, which is checked, and then they must have their doctor send their medical records.
“They can’t carry their own medical records in here. If it’s an MRI, either the doctor or the hospital has to transmit it to us. No patient is allowed to carry their medical records in, because you can get a copy of someone’s medical records,” Leadingham said, adding that it takes four to six weeks to see the doctor, as medical records and criminal histories are checked.
When patients come into the office, they are taken into a room where the staff goes over that patient’s history. All of the patient’s medical records must be sent from the referring physician.
Temponeras utilizes both OARRS (Ohio Automated Rx Reporting System) and KASPER (Kentucky All Scheduled Prescription Electronic Reporting), and is also tied in with other states, such as West Virginia and Indiana, to check for any other prescriptions that patient may have received.
“I take their background. I get all of the information from the patient,” Steve Farrell, Temponeras’ compliance officer, said. “I do OARRS. I do KASPER. We do Indiana now, and everything to make sure they don’t cheat.”
Farrell said spot checks are done, and patients are called and given two hours to come in with their filled prescriptions, and if they have less than they should have, they are discharged as a patient.
Leadingham places orders for medications online through a system that first sends that order through the Drug Enforcement Agency (DEA), then on to the company they order from.
Asked how some patients in the region have been able to get multiple prescriptions in a short period of time from several physicians, Temponeras’ attorney, Steven Hillman, said it’s simple.
“OARRS is 30 days behind. When they check the OARRS report, the information that this office sees on an OARRS report, and they see it on every patient, that information is at least 30 days old,” he said.
Leadingham said the practice would link with all states if it was available.
“We would do Florida if they were online, and all the other states if we could get them,” Leadingham said. “And that is done every month by a registered nurse. She sits in that chair. She puts it into a folder. He (Farrell) checks it when a patient comes in.”
Across from the waiting room is where the prescriptions are filled.
In the area where prescriptions are filled, patients look through a bullet-proof window where a box with a door on either side provides a space for the transaction to take place. Next to that window is a plain sheet of white paper with the prices of all of the pain medications dispensed out of the office. For example, next to the word “Oxycontin 80 milligrams” under 30-day supply is the figure $385; 60 days — $768; 90 days — $1,152, while the price for a 120-day supply is $1,536 and $1,920 for a 150-day supply. The list goes on.
Temponeras explained the difference between Oxycodone and Oxycontin. To begin with, there is no generic form of Oxycodone or Oxycontin.
“Oxycodone is immediate release. So that medicine breaks down quickly in the body. Oxycontin is slow release. It is supposed to last anywhere from 8 to 12 hours,” Temponeras said. “The patent on that release formula is much more expensive.”
Temponeras was asked why she became a dispenser instead of just writing prescriptions to be taken to other pharmacies.
“We were, in a way, forced to do that because our patients didn’t have a safe and reliable facility to go to for their medication, and they were legitimate and they needed a constant and reliable source for their medication,” Temponeras said. “What happened is, a lot of local pharmacies got scared or didn’t want the hassle, or thought they would get robbed, and didn’t want to deal with pain medicine. Those who did, we didn’t want to overburden them. So in order to keep my patients getting their medication on a supply I thought was the best medicine for them, we had opened this place. This place is exclusively for our patients so they can get medical treatment.”
The dispensary, Leadingham said, is incorporated as a for-profit company and operates on a low percentage of profit.
Behind the window where the prescriptions are filled is a room with a monitor that shows multiple camera angles for security purposes, and a large vault is off to one side.
Temponeras accepts insurance for prescriptions, but does not accept insurance for the actual office appointment. She says it is because of the length of time taken by insurance companies to pay claims.
Farrell was asked if Temponeras ever prescribed any other type of treatment other than just pain medication for any patients.
“If the doctors see to that, they are required to have therapy and things like that,” Farrell said.
Hillman said that by the time the patients are sent to that facility, they have been treated by doctors such as neurosurgeons in Columbus, and all that can be done at that point is to manage their pain.
“The neurosurgeon has already said, ‘I do surgery. The surgery is already done. It didn’t work.’ It didn’t work, but they are still in pain,” Hillman said.
“The reason she hired me was to keep trouble away from their doorstep, not to defend them once they are in trouble,” Hillman said. “That’s what I’m here for. I don’t do any criminal work. I haven’t done any criminal work in over 30 years.”
Hillman was also asked about his name appearing on certificates for LLC’s that operate other pain clinics, where the owner’s names are not listed.
He said a lot of companies, including major corporations have their attorneys sign those papers.
Temponeras said she has ties to the community where she operates her pain clinic. Ties that go back a number of years.
“At the end of this year I will have been here for 10 years,” Temponeras said. “Originally, I had opened one of the offices for SOMC in 1997, so I have been here practically my whole medical career.”
At one point during the conversation with Hillman and Temponeras, both said they welcomed laws that would require licensing for pain clinics, something being proposed by Ohio Gov. Ted Strickland in the formation of a task force to look into the problem of illegal sale and use of prescription medications.
According to Hillman, the greatest source of illegal prescription drugs appears to be the “Florida Pipeline” — people traveling to Florida and hitting several doctors and pharmacies for prescriptions and bringing them back to Ohio to sell.
“This is a matter for the authorities. We do not pretend to have any expertise in criminal matters but we will cooperate with any law enforcement agency,” Hillman said. “One must keep in mind that there are many persons in need of a regimen to control chronic pain and these people should not be demonized or abandoned as collateral damage.”
Hillman said Temponeras and her staff welcome the Action Team and other committees to sit down with them to assist in coming up with a proposal “so that we do not abandon those people with a true need for pain control and treatment” and “assist the authorities in identifying abusers.”
“There is no silver bullet solution,” Dr. Johnson said. “We must do all we can to be sure that legitimate physicians are aware of the problem of prescription drug abuse and diversion, and they, in turn, must immediately begin to do their part in curtailing drug-diverting activity.”
FRANK LEWIS can be reached at (740) 353-3101, ext. 232 or firstname.lastname@example.org.
DEBORAH DANIELS contributed to this story.