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MADISON, WIS. – Scott C. Blader and Matthew D. Krueger, United States Attorneys for the Western and Eastern Districts of Wisconsin, respectively, announced February 4 that their offices have observed a substantial decrease in opioid prescribing among medical providers who received warning letters as part of last year’s opioid initiative.
Last February, the United States Attorneys’ Offices sent letters to more than 180 Wisconsin physicians, physician assistants, and nurse practitioners advising that a review of their prescribing practices showed that they were prescribing opioids at relatively high levels compared to evidence-based prescribing guidelines. The letters warned that these prescribing practices could be contributing to the flow of prescription opioids into illegal markets and could lead to civil and criminal enforcement actions. Thanks partly to this initiative and the consistent efforts by the Wisconsin medical community to stem over-prescribing, Wisconsin has seen substantial progress in the fight against opioid abuse.
Last year’s opioid initiative has also led to meaningful discussions and collaboration amongst members of the law enforcement and medical communities. In April, the United States Attorneys’ Offices coordinated a roundtable discussion in Madison, where representatives from federal and state law enforcement and the Wisconsin medical community discussed collaborative methods for stemming opioid overprescribing among the state’s prescribers. In October, the United States Attorneys’ Offices met with the medical community and other treatment, prevention, harm reduction, and enforcement partners to hold an opioid and methamphetamine summit with the theme of “Making Progress Through Collaboration.” More than 500 people attended the two-day conference, which featured updates on trends from the United States Drug Enforcement Administration as well as the Wisconsin Society of Addiction Medicine. The United States Attorneys have also sent representatives to speak at hospital meetings and medical society gatherings about the dangers of opioid diversion. Through these efforts, the United States Attorneys seek to establish a dialogue with the medical community about safe and legal prescribing practices, and how best to address the state’s opioid epidemic.
In addition to the letters and outreach, the United States Attorneys and their federal and state law enforcement partners have continued to pursue cases in the past year against medical providers who knowingly prescribe narcotics beyond medical necessity. Recently, in the Western District of Wisconsin, Thomas Strick, a Wausau physician, was sentenced to three months in federal prison and one year of supervised release for diverting prescription fentanyl for personal use. In Strick’s case, the government’s investigation revealed that between 2011 and 2018, he had prescribed fentanyl patches to at least six patients without medical need and instructed those patients to return the filled prescriptions to him for personal use. In total, Strick had written 193 fraudulent fentanyl prescriptions and acquired 3,156 patches as part of the scheme. After Strick’s guilty plea, United States Attorney Blader reaffirmed his office’s commitment to holding accountable “medical practitioners who violate their oaths.” According to Blader, “our goal is to work with law enforcement and medical partners to stop addictions before they start by stemming the diversion of prescription opioids to unlawful channels.”
Likewise, in the Eastern District of Wisconsin, Steven Kotsonis, a Menomonee Falls medical doctor, and his office manager, were convicted of unlawfully distributing Oxycodone. Both face up to twenty years in prison at sentencing. After Kotsonis and his office manager pled guilty on December 17, 2019, United States Attorney Krueger said, “this case underscores the Justice Department’s commitment to combatting the opioid crisis.” He emphasized that “far too many Wisconsinites have seen loved ones suffer from an opioid addiction or, worse, an overdose. Because the path to addiction often begins with prescription opioids, we are committed to investigating and prosecuting prescribers like Kotsonis who deal drugs behind the façade of medical practice.”
The active participation of Wisconsin medical systems, medical societies, and medical regulators has been essential to reducing opioid over-prescribing in Wisconsin. Many medical systems have undertaken internal reviews of employee prescribing practices, while medical societies have reinvigorated programs aimed at training providers about safe and lawful opioid prescribing. The Wisconsin medical community is also engaged in renewed information sharing efforts designed to identify and stem pill-seeking behavior before prescriptions are written.
Due to sustained efforts of all partners, total opioid prescriptions in Wisconsin have declined by 30 percent between 2016 and 2019, according to data from the Wisconsin Prescription Drug Monitoring Program. The letters sent by the United States Attorneys appear to have amplified this downward trend. Looking at Medicare prescription data, the total amount of opioids that letter recipients prescribed from July 2017 to June 2019, decreased by about 20 percent in the Western District and about 29 percent in the Eastern District compared the total amount opioids that recipients prescribed from July 2016 to June 2018, before the letters were sent.
In the coming year, the United States Attorneys’ Offices will continue to work with the Wisconsin medical community in support of their efforts to educate providers and monitor opioid prescribing. This will include redoubling efforts to ensure that providers have access to the best information available before prescribing opioids by ensuring that law enforcement is submitting timely and accurate overdose and arrest data to the Wisconsin Prescription Drug Monitoring Program. The United States Attorneys’ Offices will also continue to monitor opioid prescribing data and take further action, as necessary, against prescribers whose practices substantially exceed evidence-based prescribing guidelines.