CHARLESTON, W.Va. - A powerful narcotic was the No. 1 prescribed drug among Medicare patients in West Virginia for 2010, and a Charleston neurologist was the top prescriber in the state.
State doctors wrote 402,159 hydrocodone-acetaminophen prescriptions for Medicare Part D patients in 2010, according to a recent study by the nonprofit investigative journalism website ProPublica. Prescriptions of the narcotic cost Medicare $5.2 million in West Virginia that year.
West Virginia wasn't the only state with high numbers of hydrocodone-acetaminophen prescriptions, however.
The drug was the third-most prescribed medicine in the nation in 2010, ranking behind the cholesterol drug Simvastatin and the high blood pressure medicine Lisinopril, according to the study. U.S. doctors wrote about 31 million hydrocodone prescriptions that year, at a retail cost of $320 million.
ProPublica obtained 2010 records for Medicare's prescription drug plan, known as Part D, through Freedom of Information Act requests. The website then compiled the data to give state-by-state, drug-by-drug and doctor-by-doctor analysis of prescriptions.
Hydrocodone-acetaminophen is better known by its various brand names: Lortab, Lorcet, Dolorex and Vicodin.
Dr. Iraj Derakhshan, a neurologist who splits his time between Beckley and Charleston, was the state's top prescriber of hydrocodone-acetaminophen in 2010, writing 4,032 prescriptions to Medicare recipients, according to ProPublica's study.
Derakhshan prescribed hydrocodone far more than other drugs. The second-most popular drug at his practice, the anti-seizure medication topiramate, saw only 1,352 prescriptions to Medicaire patients in 2010.
Of his 609 Medicare patients, 94 percent received a prescription for a narcotic in 2010.
Derakhshan said he's not surprised ProPublica ranked him first.
"Pain is the No. 1 complaint that takes a patient to a doctor, so it makes sense to write anti-pain medication. I'm a neurologist. I see a lot of headache patients," he said. "I believe it's inhumane to make a patient suffer."
He said most of his patients suffer from either migraine headaches or seizures. That's why topiramate is the second-most prescribed drug in his office: it's an anti-seizure medication, but because the conditions are related, it also can be used to treat migraines.
Derakhshan said he prescribes hydrocodone and, in severe cases, oxycodone, if other treatments are not effective.
He said it's important to relieve migraine sufferers' pain because the headaches are caused by vasoconstriction - the tightening of blood vessels in the brain - which can lead to stroke if left untreated.
"Once you get rid of the pain, that vasoconstriction goes away," he said.
Oxycodone was the third-most popular prescription at Derakhshan's practice in 2010, with 627 prescriptions written to Medicare patients.
While hydrocodone acetaminophen is not as widely abused as its pharmacological cousin oxycodone, law enforcement officers still say there is a significant street trade for the painkiller.
Of the 84 prescription drug arrests in Kanawha County in 2012, at least 18 involved some form of hydrocodone-acetaminophen.
Derakhshan said he worries about the drugs he prescribes falling into the wrong hands, and stops treating any patients he knows are selling their prescriptions on the street.
"It becomes tempting to sell it because many people, even though they have pain, they also are poor. Because the price is high, it becomes a tempting thing to do. I know some of these patients have pain, but because of a money issue they give away some of it," he said.