Charleston neurologist had history of pill scrutiny
CHARLESTON, W.Va. - A Charleston neurologist recently identified as the state's top hydrocodone prescriber came under West Virginia Board of Medicine scrutiny nearly 10 years ago for what he calls "off label" use of Oxycontin.
In October 2002, a patient complained Dr. Iraj Derakhshan advised him to take medication in an unsafe manner.
According to an order filed by the West Virginia Board of Medicine, Derakhshan told the individual to cut the pills in half. The order doesn't name the drug, but Derakhshan said Tuesday it was Oxycontin, a powerful painkiller.
Derakhshan denied the patient's accusations, telling the medical board the patient was not in any danger as long as they followed his instructions.
Another patient filed a complaint in March 2003. Derakhshan again denied the allegations but appeared before the medical board's complaint committee to discuss them. The committee conducted an investigation, including a look at the patient's medical records, pharmacy records and a review by an independent medical consultant.
The complaints were settled by mediation in April 2005. The board ordered Derakhshan to complete a course in "controlled substance management" and record keeping within 10 months of the ruling.
Derakhshan also agreed to stop advising patients to cut time-released medications in half and limit his practice to 25 patients per day, excluding hospital visits. He completed the required courses in November and December 2005 at Case Western University in Cleveland.
The board's actions also earned Derakhshan similar penalties in California, Ohio and Washington, D.C., where he also is licensed to practice.
While it is common to cut some pills in half, splitting some medications disables the time-release effect. Although Oxycontin's guidelines warn against cutting the pills in half, Derakhshan said that has not always been the case.
He said in the early 2000s, the drug's manufacturer only advised against chewing and crushing the pills. Derakhshan maintains his advice to cut the pills in half fell under "off label use," where doctors prescribe drugs outside the manufacturers' recommendations.
"It's my job as a doctor. More than 50 percent of uses of medications are off-label," he said.
He said he studied Oxycontin and determined cutting the pills in half would not harm his patients.
"The structure of those pills, I had studied. I had talked to (drug manufacturer Purdue Pharma) myself," he said.
Derakhshan said Purdue confirmed his belief that cutting the pills in half would not harm patients.
However, Oxycontin's current instructions advise patients should not "crush, chew, or break an extended-release OxyContin tablet. Swallow it whole."
According to a study by the nonprofit investigative journalism website ProPublica, Derakhshan was the state's top prescriber of hydrocodone-acetaminophen in 2010 among Medicare Part D patients.
He wrote 4,032 hydrocodone prescriptions to Medicare recipients that year, according to ProPublica. Of his 609 Medicare patients, 94 percent received a prescription for a narcotic in 2010.
Derakhshan said he prescribes hydrocodone to treat headache patients. He said the bulk of his patients suffer either from migraines or seizure.
"The practice of medicine is paralyzed without use of narcotics. I personally believe that opium is truly a blessing, but there's a prohibition," he said.
He said the medical community has demonized prescription pain medications.
"By making doctors scared, they are depriving patients from access to pain medicine," he said.
Hydrocodone-acetaminophen is better known by its various brand names: Lortab, Lorcet, Dolorex and Vicodin. According to a recent study by the Journal of the American Medical Association, hydrocodone overdoses killed more than 16,600 people throughout the United States in 2010.
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