Duped in cough-syrup drug fad, doctor says

LITTLE ROCK — Dr. James Miller said he had never heard of the street drug concoction "purple drank" or "sizzurp" until a state investigator showed up asking why he was prescribing so much of its key ingredients.

The West Memphis doctor said he had no idea that drug abusers mix the purple cough syrup with soda and a Jolly Rancher and drink the cocktail for a euphoric high. Miller began to get suspicious, he said, after hundreds of patients began crossing the state line from Memphis to come to his office. They all claimed to have back pain or chest pain and a bad cough.

For many of them Miller prescribed hydrocodone, an addictive pain killer, and the cough syrup Phenergan Expectorant with codeine. He says patients manipulated him into giving them the medication.

"I've prescribed Phenergan and codeine for kids for 25 years," he said. "You just don't expect people on the street to be taking such a common medicine."

But the state physician licensing board thinks he should have known better. He now faces a December hearing to determine whether he should lose his medical license.

Miller is not the first doctor to find himself in the middle of this cough syrup fad, and West Memphis is only the latest community seeing it.

"It's called city syrup here in Houston," said Dr. Ronald J. Peters, an assistant professor at the University of Texas Health Science Center. "We had a major trend of this particular endemicfor the last probably 10 years."

The trend popped up first in Houston and was popularized by rapper DJ Screw, who slowed down the music he remixed to recreate the effect of the cough syrup high. The 30-year-old Houston hip-hop artist overdosed on the medication in 2000, but other music released around the same time - such, as Big Moe's album City of Syrup and Memphis rap group Three 6 Mafia's song "Sippin' on Some Syrup" - helped make it part of the culture.

Peters said in Houston "crooked" doctors and pharmacists sometimes work together writing and filling numerous prescriptions for quick money. Last year a Houston doctor and three pharmacists were indicted on charges of conspiring to dispense and distribute hydrocodone and promethazine with codeine, the cough syrup's generic ingredients. In 2005, another Houston doctor and six pharmacists wereconvicted on similar charges.

Law enforcement in Houston has cracked down on the abuse of the cough syrup there, Peters said, and now the problem has begun cropping up in other parts of the country.

In February former San Diego Chargers safety Terrence Kiel pleaded guilty to felony and misdemeanor charges after the U.S. Drug Enforcement Administration said he had admitted to shipping the cough syrup from California to Texas.

The DEA in Arkansas said the problem has surfaced on Arkansas highways as well. State police have nabbed people transporting two and three cases of the medicine across Arkansas interstates.

The cough syrup has also increasingly become a target in pharmacy break-ins. In 2004 promethazine with codeine was stolen in at least one drug store burglary, according to an informal count tracked by the Arkansas State Pharmacy Board. In 2006 the cough syrup was involved in at least 13 break-ins. So far, in 2007, the cough syrup has been a target in at least six break-ins, including a North Little Rock robbery earlier this month in which a pharmacist was shot.

John Kirtley, the board's assistant director, says his agency has had no licensing hearings against pharmacists for selling the cough syrup when they know they shouldn't. But two pharmacy technicians have gotten into trouble for stealing about 350 pints of the medicine between them.

One pharmacy tech wound up with a felony conviction, while the other had her pharmacy technician's permit revoked for at least 15 years.

Part of the drug's allure is the increasing street value of "purple drank." A four-ounce prescription of the cough syrup costs about $12 in a pharmacy, Kirtley said, or about $48 for a pint, which contains 50 to 100 doses. On the street a pint can be sold for as much as $300 or $325.

The "purple drank" fad has been bubbling up in Arkansas over the past two or three years, Kirtley estimates, but it's only now becoming more widely recognized among pharmacists.

"We all, as pharmacists, think everyone wants pills," he said. "And people are stealing cough syrup."

In West Memphis, police and pharmacists say that abuse of the medicine has become a noticeable problem in the community. One pharmacy, City Drug Store,stopped carrying the cough syrup altogether, said an employee who declined to give his name. "A bunch of thugs" kept coming in with prescriptions for it. The pharmacy went from selling a pint every two or three weeks to seeing 25 to 30 customers a day with prescriptions.

Miller, the doctor now at odds with the Arkansas State Medical Board, said he had never heard of the street concoction "purple drank" when he was bombarded with patients who complained of bad coughs.

He said he was quickly overwhelmed after he agreed to see the patients of two Memphis doctors who recently died. Within a few months, Miller had 2,500 new patients, many with the same symptoms.

The Arkansas State Medical Board has accused Miller of prescribing excessive amounts of codeine cough syrup to six patients. For some of those patients, Miller's medical records didn't adequately reflect the need for medication, according to a board order. For others, Miller "knew or should have known that the patient was utilizing said medication for nontherapeutic reasons," the order says. In addition to the cough syrup, the board is accusing Miller of overprescribing pain medication, including Oxycontin and hydrocodone.

The order also notes that the West Memphis Police Department alerted the board to 27 other patients who told officers they had received unspecified controlled substances from Miller "without adequate need" for the medication. Two arrest reports and 25 incident reports involving Miller's patients - mostly traffic stops - were filed by police.Still, some of those reports detail patients simply leaving Miller's office with prescriptions.

At the same time, Kirtley said pharmacists in Mississippi and Tennessee notified the Arkansas pharmacy board about the unusually large number of patients coming in with Miller's prescriptions. And Tennessee pharmacists complained to the Medical Board that Miller's patients seemed to arrive in groups.

Miller, who has practiced in West Memphis for about 30 years, denies handing out prescriptions to patients who didn't need them, and said none of his patients ever got too much medicine. He said he took vital signs and physically examined every patient, but he acknowledged seeing several patients together in one exam room, an unusual medical practice.

His clinic just got "caught up in something awful," he said.

Peters, who has been watching the situation in Houston for years, said getting the cough syrup can be a simple scam to pull over on unsuspecting doctors.

"It's real easy for people to tell you that they have a history of a cough and then to fake a cough," he said. "And the reality is places that are not as well informed, the people may get over on a few doctors that are may be in a small town that don't know this is a problem."

In August, the Medical Board suspended Miller's license, pending a hearing. About three and a half weeks later, the board agreed to restore his medical license until the December hearing, but asked Miller to give up his DEA registration. Without it he cannot prescribe controlled substances,including the codeine cough syrup.

Miller says he's not worried about losing his license. He believes the board will understand his situation after he's had a chance to explain it to them.

"We got manipulated badly," he said.