But more significantly, the number of doctors and nurse practitioners who reported receiving payments shrunk by 51%, from 204 to 99.

“I would assume it was the stigma,” said Dr. Arthur Gale, contributing editor at Missouri Medicine. “You can’t pick up a newspaper and not read about Purdue. Even the greatest promoter of OxyContin and narcotics, Dr. Russell Portenoy, is now saying he was exposed to false information.”

Data from the Centers for Medicare and Medicaid Services (CMS) show that a small group of doctors in Connecticut received the bulk of payments during the two years. The top five recipients are Dr. Thomas Pellechi ($747,429), an internist in Greenwich; Dr. Michael Brennan ($41,611), a physiatrist who specializes in rehabilitation medicine in Fairfield; Dr. Howard Hochster ($11,541), an oncologist in New Haven; Dr. Dean Mariano ($10,680), an anesthesiologist in Meriden; and Dr. Lucien Parrillo ($205), an internist in Portland.

The number of doctors and nurse practitioners receiving payments from Purdue dropped 51%.

Pellechi, employed as a company doctor for Purdue of Stamford while also maintaining a private practice, earned the most of any physician—a total of $1.877 million from 2014 to 2018—more than three-fourths of the $2.24 million Purdue paid out during that period.

“The only conflict of interest is if I overprescribed, and I barely prescribed OxyContin,” he said. A review of the Medicare Part D prescription database showed Pellechi was not listed as a provider. His position with Purdue ended in mid-2019.

Even though individual payments from Purdue dropped sharply, critics argue that some doctors, such as Brennan, took too much. Brennan was paid a total of $150,555 between 2014 and 2018.

“Doctors like Michael Brennan received larger payments because they are in a category called ‘Key Opinion Leaders,’” said Dr. Andrew Kolodny, medical and co-director of the Opioid Policy Research Collaborative at Brandeis University. Kolodny has been a paid expert witness in opioid lawsuits. “Doctors were hearing from [and influenced by] pain specialists like him with a thriving private practice.”

When contacted, Brennan directed an office staff member to refer any questions to a study on the risks of withdrawing from opioids rapidly.

The financial relationships between pharma payments to doctors and their prescribing habits have been scrutinized for years.

A June 2019 study of prescribers under Medicare Part D in the journal Addiction found that “physicians who receive direct payments from providers for opioid prescribing tend to prescribe substantially larger quantities, particularly for hydrocodone and oxycodone.” The study said that doctors who took payments from opioid companies prescribed 8,784 daily doses of an opioid per year in excess of prescriptions made by their peers, who did not receive such payments.

“Doctors like Michael Brennan received larger payments because they are in a category called ‘Key Opinion Leaders.’ Doctors were hearing from [and influenced by] pain specialists like him with a thriving private practice.”

— Dr. Andrew Kolodny

Based on an analysis of Medicare Part D prescriptions in Connecticut, the top recipients of Purdue money had the following prescription rates in 2017, per the latest data: Opioids consisted of 71.91% of Brennan’s 7,202 prescriptions overall; 62.39% of Parrillo’s 2,963 prescriptions; and 9.77% of Hochster’s 133 prescriptions.

Other high prescribers of opioids who also accepted money from Purdue include Dr. Mohan Vodapally (72.79% of 6,431 prescriptions); Dr. Anand Rahul (34.3% of 1,029); Dr. Robert Boolbol (52.13% of 3,401); Dr. Vincent Carlesi (46.25% of 2,536); and Dr. Igor Turok (46.89% of 2,730).

Not all doctors who were paid by Purdue were listed as prescribers of opioids in the Medicare Part D database.  Dr. Joshua Hurwitz, a reproductive endocrinologist in Danbury, for example, was paid $2,227 in 2014 for consulting work in the area of women’s health and hormones, but was not listed as a prescriber of opioids.  “This is an example of appropriate physician consulting that has nothing to do with the opioid epidemic,” said Hurwitz.

“What’s the difference between consulting and giving talks on behalf of certain drugs?” pharma critic Gale asked. “Doctors shouldn’t accept money from drug companies because it’s tainted.”

Purdue paid 563 prescribers small amounts ranging from $10.18 to $200.17 between 2014 and 2018, indicating a free meal at an event or lunch with a sales rep.

But there’s no such thing as a free lunch, Kolodny pointed out. “Medical literature show that these small payments influence doctors’ prescribing habits, and that’s why Purdue did it.”

Purdue announced in 2018 that it would no longer send sales reps to doctors’ offices. But state attorneys general, including William Tong of Connecticut, say the damage is done. A lawsuit by the state of Connecticut alleged that a patient taking the lowest dose twice a day for a week earned Purdue $38. But if the patient instead took the highest dose, Purdue made $210—an increase of 450%. To obtain that revenue, Purdue formulated its sales strategy to increase prescribed doses, the lawsuit says.

Purdue’s flagship drug, OxyContin, was launched in 1996 with the highly addictive oxycodone as the single active molecule.  Oxycodone has had devastating consequences in Connecticut.  According to the Connecticut Office of the Chief Medical Examiner, between 2012 and 2019, there were 707 accidental overdose deaths involving oxycodone, though the Office does not indicate how many, if any, of these deaths involved OxyContin.

Deaths from all opioids climbed to 5,790 over the eight-year period, the state reports.

An October 2019 study by Yale University and the University of Connecticut published in the journal Drug and Alcohol Dependence found that overdose deaths from opioid use in Connecticut doubled in the last six years as a result of fentanyl and polysubstance abuse.

Findings such as these could explain why a drop in prescriptions alone doesn’t tell the full story. “There are a lot of pathways to addiction,” said Dr. Gregory Shangold, an ER physician in Willimantic.

CORRECTION: An earlier version contained incorrect information concerning Dr. Joshua Hurwitz.  He was not listed as a prescriber.  He was paid $2,227 for consulting work in the area of women’s health and hormones. C-HIT apologizes for the inaccuracy. 

This story was revised from an earlier version.

Matthew Kauffman, a freelance data specialist, contributed to this story.

Heather Alfonso, an advanced practice registered nurse (APRN) at the Comprehensive Pain & Headache Treatment Centers, LLC, in Derby, surrendered her controlled substance registration after a recent probe by the Drug Control Division of the Department of Consumer Protection, a spokeswoman for the department confirmed.

“The controlled substance registration of this provider has been turned in,” said the spokeswoman, Claudette Carveth. She said the agency had no further comment.

Meanwhile, William Gerrish, a spokesman for the Department of Public Health, said his agency has an ongoing investigation into Alfonso’s APRN license, which is separate from her prescribing registration. The DPH licenses nurses and can sanction providers.

Alfonso could not be reached for comment Monday. She and Dr. Mark Thimineur, an anesthesiologist who is medical director of the privately run pain center, housed in Griffin Hospital, previously did not respond to messages seeking comment.

In testimony late last month to a Congressional committee about the state’s drug-control efforts, John Gadea, Jr., director of the Drug Control Division of the Department of Consumer Protection, disclosed that his agency, working with the DPH and the U.S. Drug Enforcement Administration (DEA), had “just completed a case against (Heather Alfonso), a midlevel practitioner, that has resulted in the surrender of federal and state controlled substance registrations. The same practitioner was recently identified as one of the top ten prescribers of controlled substances in the country.”

Gadea was referring to the Feb. 19 C-HIT story, which identified Alfonso as among the top 10 prescribers nationally of the most potent controlled substances in Medicare’s drug program in 2012 – an anomaly in a state where Medicare records show nurse practitioners rarely prescribe such Schedule II drugs, which have a high potential for addiction and abuse.

Alfonso wrote out 8,705 prescriptions for opioids and other Schedule II drugs in 2012 – the highest prescriber among all Connecticut practitioners, including pain specialists and other physicians, according to Medicare data compiled by ProPublica, a national news organization.

Alfonso wrote out more prescriptions for the opioid Exalgo than any other Medicare provider in the country, and was the seventh highest prescriber nationally of Oxycontin, writing out more than twice as many prescriptions for that narcotic as the next highest prescriber in Connecticut. She also was the 10th highest prescriber nationally of Avinza, a morphine product.

The Medicare records from 2012 – the most recent year for which data is available publicly — showed that 94 percent of Alfonso’s patients received at least one prescription for a potent Schedule II medication. Other nurse practitioners in Connecticut wrote such prescriptions rarely or not at all, according to the federal data compiled by ProPublica. Alfonso issued an average of 18 prescriptions per patient – double the average for nurse practitioners – the data show.

Asked about Alfonso’s prescribing rate, a spokeswoman at the pain center said in February, “We are a very large practice for pain management, and with our patients’ (complex) diagnoses, those are factors.”

Alfonso’s prescribing practices had come to the state’s attention last summer, when she received a reprimand and $2,000 fine from the Board of Examiners for Nursing for improper prescribing practices related to one patient. But she was allowed to continue practicing without restrictions, and there is no indication in the records that the DPH or the board had reviewed her level of prescribing.

In that case, Alfonso was cited for providing narcotic pain medications to a non-cancer patient seven times without personally examining the patient, instead “inappropriately” relying on an unlicensed assistant to examine the patient, state records say.

Thimineur had fewer Medicare prescriptions for controlled substances than Alfonso; he was the third-highest prescriber among pain medicine specialists in the state in 2012, data show. Like Alfonso, most of his prescriptions were for Schedule II drugs.

Gerrish has said the DPH and the state medical board do not monitor the prescription database, which is maintained by the consumer protection department’s Drug Control Division. Instead, health officials access the database only when there is a complaint or referral. The consumer agency is empowered to notify law enforcement or regulatory agencies of any improper prescribing activity.

In the past several years, a number of Connecticut physicians have been charged with illegal prescribing of controlled substances. The DEA is involved in cases that result in criminal charges.

The federal Centers for Medicare & Medicaid Services (CMS), which oversees the Medicare program, has been slow to police high prescribers. The agency adopted regulations last year that will allow it to remove providers from the program – starting in mid-2015 — if it finds a pattern of prescribing that is “abusive,” or if a state suspends or revokes a provider’s ability to prescribe.

In Connecticut, state officials have taken several steps to stem an increase in opioid prescribing and overdoses. In January, the Connecticut Hospital Association joined the DPH and two physicians’ groups in endorsing a set of “voluntary guidelines” aimed at reducing opioid prescribing in hospital emergency departments.

Gov. Dannel Malloy has proposed several initiatives designed to stem substance use and opioid overdose, including one that would require any prescriber supplying more than a 72-hour supply of a controlled substance to first review the patient’s record in a statewide prescription database. Malloy’s proposals stop short of initiatives in some other states which have health agencies and medical boards using prescription data to spot problem prescribing, mandate drug screening for patients on long-term opioid treatment, or impose special regulations on pain management clinics.