Doctor defends giving drugs

A pain-management doctor from McLean accused of using his office as a front for drug trafficking acknowledged yesterday that he prescribed massive amounts of opiates for some of his patients, but said he always had a medical reason for doing so.

Dr. William E. Hurwitz, accused in U.S. District Court in Alexandria of drug trafficking resulting in the deaths of two patients and other charges, took the stand in his own defense yesterday.

Dr. Hurwitz testified that he knew some of his patients were drug abusers who were taking cocaine or abusing his prescriptions. But he said he felt compelled to continue treating them with drugs such as OxyContin — or at the very least to refrain from abruptly canceling their prescriptions — because of the withdrawal they would suffer after taking such high doses.

“Abrupt termination of these medicines is tantamount to torture,” Dr. Hurwitz testified.

Dr. Hurwitz frequently prescribed 100 tablets or more of OxyContin tablets for his patients as they developed tolerance to lesser doses. Court testimony during the trial, which began Nov. 4, indicated that at least one patient received a prescription for 1,600 pills a day.

Dr. Hurwitz, who has had frequent run-ins with state medical boards, testified that the body quickly develops a tolerance for opiates such as morphine and OxyContin. The best way to combat that, he said, is to rotate the drugs used and to increase the dosage when needed, often by doubling it.

He said that the human body can tolerate massive amounts of opiates without physical damage and that the risk of addiction is overstated. He also said the physiology of such drugs leaves a user with an increased sensitivity to pain if they are abruptly taken off a drug.

One of Dr. Hurwitz’s patients, according to testimony, obtained an early refill of an OxyContin prescription by telling Dr. Hurwitz that the dog had eaten the initial prescription. Dr. Hurwitz also had seen what appeared to be track marks on the woman’s arms, which she said she had received by hauling some wood.

Dr. Hurwitz said he didn’t necessarily believe her excuses, but continued her treatment because, “If the treatment was going to be terminated, it should be done in a tapered, rational way.”

Some of Dr. Hurwitz’s patients were using the prescriptions they received to deal drugs; many have struck plea bargains and testified against him at trial. Prosecutors have played audiotapes to the jury that they say are proof that Dr. Hurwitz knew these patients were dealing drugs and that he turned a blind eye.

Dr. Hurwitz testified that he did not know any of his patients were dealing drugs.

Dr. Hurwitz’s office was raided in November 2002 by agents from the Drug Enforcement Administration after being identified in an ongoing federal investigation of doctors suspected of overprescribing controlled drugs. The agents, armed with search warrants, took patient files and financial and other records and copied the hard drives on many of the doctors’ computers.

On Sept. 25, 2003, he was named in a 49-count indictment by a federal grand jury. The charges include conspiracy to traffic in controlled substances, drug trafficking resulting in death and serious bodily injury, drug trafficking, engaging in a continuing criminal enterprise and health care fraud.

Expert witnesses have testified for both prosecutors and the defense, differing on whether Dr. Hurwitz’s prescriptions were medically justified. Among those to testify on Dr. Hurwitz’s behalf was Dr. Russell Portenoy, chairman of the pain-management department at Beth Israel Medical Center in New York and considered to be one of the world’s leading experts on pain management.

Dr. Hurwitz treated nearly 500 patients from 39 states in the late 1990s through 2002, receiving a $1,000 initiation fee and monthly fees of up to $250 for each patient in the practice.

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