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Charleston doctor is W.Va.'s top prescriber of hydrocodone

CHARLESTON, W.Va. -- A Charleston neurologist who prescribed hydrocodone more than any other doctor in the state in 2010 had been disciplined twice before by the West Virginia Board of Medicine.

Dr. Iraj Derakhshan, who also practices in Beckley, wrote 4,032 prescriptions for hydrocodone to Medicare patients, according to a study released earlier this month by ProPublica, a nonprofit investigative news source.

Hydrocodone -- often known by brand names Lortab, Vicodin, Lorcet-HD, Hycodan and Vicoprofen -- is a schedule III controlled substance.

Derakhshan prescribed hydrocodone more than any other drugs he prescribed that year. Second was Topiramate, a seizure and migraine medication for which Derakhshan wrote 1,352 prescriptions in 2010.

ProPublica's study, released May 11, looked at the top prescriptions written to Medicare Part D patients. Part D is Medicare's most popular prescription drug program and serves more than 35 million people, according to ProPublica.

This is the first time the names of the prescribers and the drugs they prescribe have been made public.

Hydrocodone acetaminophen also was the top drug in West Virginia for the number of prescriptions written for Medicare Part D participants. There were 402,159 claims for the medication in 2010.

Hydrocodone was the most frequently prescribed opiate in the U.S. last year, with about 143 million prescriptions written, according to the U.S. Drug Enforcement Administration.

Diverted pharmaceuticals are the primary source of the drug for abusive purposes, according to the DEA. Those are drugs that, for instance, are prescribed appropriately but end up being used illegally by people other than the patient.

Overall, hydrocodone acetaminophen is the third most prescribed drug for Medicare patients in the U.S. The drug had 28 million claims by Medicare Part D patients in 2010, according to ProPublica.

Since 1990, the state Board of Medicine has twice reprimanded Derakhshan.

In the most recent board action, in 2010, Derakhshan was publicly reprimanded and made to pay a $2,000 fine for answering "no" to a question in a renewal application about whether he had any limitations, restrictions or conditions placed on his license to practice medicine. But the Medical Board of California had previously reprimanded Derakhshan, according to the consent order from the state Board of Medicine, which he failed to report.

The West Virginia Board of Medicine also reprimanded him in 2005 for advising patients to cut time-release medications in half with a pill cutter. In a related consent order, the board required that Derakhshan not examine or treat more than 25 patients in one day and that he take courses in controlled substance management and recordkeeping.

Derakhshan said Monday he frequently prescribes hydrocodone for severe leg pain in diabetes patients. Derakhshan treats patients who are referred to him, he said.

"Many people in this state are obese and have diabetes," he said. "Diabetes is a neurological illness with some nonneurological symptoms."

About half of Derakhshan's Medicare Part D patients have diabetes, he said.

"This state has the highest rate of obesity, and diabetes [has] a direct relation to a person's weight," he said.

Derakhshan also prescribes hydrocodone for migraines, which he said is one of the top illnesses people see a doctor for.

"Hydrocodone is commonly prescribed to get rid of a headache," he said. "[Migraines] are not a benign condition. They're commonly associated with stroke or seizure. [Patients with migraines often] end up having a stroke or a seizure because seizure and migraine, in my opinion as an informed neurologist, are the two sides of the same coin."

Derakhshan said that while he follows DEA guidelines, it's difficult for physicians to know whether patients are abusing or selling medications.

He requires patients to sign a contract stating they will use them as prescribed and not sell them, he said. He dismisses patients he hears are abusing or selling the drugs, he said.

Derakhshan has previously been featured in the Gazette for his theory that one side of the brain is dominant. This idea differs from the accepted theory that one side of the brain controls the opposite side of the body.

An April story in the Gazette featured his theory about Rep. Gabrielle Giffords' brain surgery and the role that being left-handed or right-handed played in her recovery.

Reach Lori Kersey at lori.kersey@wvgazette.com or 304-348-1240.


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