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Journal Inquirer
Beleaguered doc was biggest Medicaid prescriber of pain ‘lollipop’
By Don Michak

A Berlin psychiatrist whose license to practice medicine was suspended last summer ranked among the biggest prescribers of eight pain and mental health medications — including federally controlled narcotic drugs — charged to the Medicaid program in Connecticut, state Department of Social Services records reveal.

The documents show that Gerson M. Sternstein, a pain management specialist whose patients came from throughout the Hartford-New Britain area, wrote a total of 14,635 prescriptions in 2008 and 2009, for which Medicaid was billed more than $5.6 million.

In several instances, Sternstein wrote twice as many or more prescriptions than the second-highest prescriber on the state’s top 10 list for the same drug. Last year, for example, he wrote 3,117 prescriptions for a formulation of oxycodone — OxyContin and Roxicodone — 1,938 more than the No. 2 prescriber.

Moreover, Sternstein was the state’s single biggest prescriber in both 2008 and 2009 of that drug as well as two other oxycodone formulations and one other medication, which are federally controlled narcotics and classified as opiate analgesics.
He topped the list of prescribers of Actiq, or fentanyl citrate, which is intended to treat “breakthrough” pain in cancer patients and dosed as a white, berry-flavored “lollipop.” In 2008 he wrote 604 scripts for Actiq, which is said to be 80 times stronger than morphine, and 266 in 2009. That cost Medicaid $1.12 million the first year and $514,849 the second.

Sternstein also ranked as the top prescriber in both years of the three oxycodone formulations:

• He wrote 2,023 prescriptions in 2008 and 3,117 in 2009 for OxyContin and Roxicodone, or oxycodone HCL, costing Medicaid $568,807 and just over $1 million, respectively.

• He also wrote 1,018 prescriptions in 2008 and 960 scripts in 2009 for OxyContin, or oxycodone HCL CR, for which Medicaid was billed $440,090 and $467,852, respectively.

• Similarly, he wrote 1,012 prescriptions in 2008 and 1,822 in 2009 for Roxicodone, or oxycodone HCL IR, at a cost $130,920 and $851,277, respectively.

Sternstein last year also was the state’s biggest prescriber of Xanax, or alprazolam, a benzodiazepine used to treat anxiety disorders and panic attacks. He wrote 1,153 prescriptions in 2009 and 723 in 2008, when he was the second-biggest prescriber. Medicaid was charged $32,167 in 2009 and $17,609 in 2008.

Sternstein in those years also ranked fourth and sixth on the list of top 10 prescribers of Abilify, or aripiprazole, a drug known as an atypical antipsychotic and antidepressant used to treat symptoms of schizophrenia. He wrote 568 scripts in 2008 and 585 in 2009 for which Medicaid was billed $119,236 and $151,677, respectively.

Over the same period Sternstein also made the lists of top 10 prescribers of two more drugs.

He ranked tenth in 2008 and second in 2009 in scripts for Duragesic, or fentanyl, an opiate analgesic dosed through skin patches to relieve longlasting moderate to severe pain. He wrote 143 prescriptions the first year and 219 the second, costing Medicaid $55,277 and $102,240, respectively.

Sternstein also was the eighth-biggest prescriber in 2008 of Risperdal, or risperidone, an antipsychotic used to treat symptoms of schizophrenia and episodes of mania as well as behavior problems. He wrote 422 prescriptions at a cost of $32,139.

Sternstein, facing allegations that he overprescribed pain medications, testified last week before a subcommittee of the Connecticut Medical Examining Board that the charges were baseless.

But the psychiatrist, who is the sole physician in his practice, Paragon Behavioral Health, also said he wouldn’t resume treating chronic pain patients should the board restore his license, which state regulators suspended in August.

The Department of Consumer Protection has identified Sternstein as the No. 1 prescriber of controlled drug prescriptions in the state from July 6, 2008, to Aug. 6, 2009, according to a report prepared for the state health department’s practitioner licensing and investigations section.

That report said Sternstein authorized the use of 2.4 million controlled doses for 1,496 clients, which it said “averaged out to 16 prescriptions per client.” The report compared that number to Yale New Haven Hospital, which it said ranked third on the list with 1.7 million controlled drug doses for 20,689 clients, or an average of eight prescriptions per client.

The report also disclosed that Consumer Protection Department and federal Drug Enforcement Administration records show that Sternstein had surrendered his respective registrations in 1988 for treating drug addicts by writing controlled substance prescriptions. It said that the “privilege” to prescribe such substances was reinstated in 1993.

Sternstein’s lawyer has disputed that part of the report, saying the real reason the psychiatrist gave up the registrations was that he had developed a substance-abuse habit, which he reported to the authorities.