Along one massive front of the war on drugs, where fortunes are amassed and lives destroyed, barely a skirmish has been waged.
Every year, hundreds of millions of prescription pills flow into the nation's illicit drug market, creating a giant cornucopia of painkillers, stimulants and tranquilizers. They are believed to be among the most abused substances in the country, even rivaling the estimated use of cocaine and crack.
But in California and elsewhere, only a few agents, often equipped with the most lenient narcotics laws, investigate the illegal trafficking of powerful pharmaceuticals by doctors and others. In this backwater of enforcement, recognition comes hard and frustrations abound.
"There is just no glory in it--no guns, no piles of coke, and no bundles of cash to stack up for the TV cameras," said Special Agent Walter Allen III of the state Bureau of Narcotic Enforcement, who supervises prescription fraud cases.
It seems the only time prescription drug abuse gets serious attention is when a celebrity tumbles--be it Betty Ford, Elizabeth Taylor or superstar producer Don Simpson, who died of an overdose in January from a lethal mix of cocaine and 20 prescription drugs.
In an extraordinary effort, authorities from local, state and federal law enforcement agencies are investigating more than a dozen doctors suspected of unlawfully supplying prescription drugs to the producer of such hits as "48 Hours," "Top Gun" and "Beverly Hills Cop."
On Friday, the offices of two of those doctors, both psychiatrists, were raided by investigators. The home of one also was searched.
"Abuse of prescription drugs is a serious problem in our society, but nobody pays attention until somebody big and powerful like Don Simpson drops dead," said Steve Simmons, the California Medical Board's senior investigator on the case. "But this kind of thing happens all the time to lots of regular folks."
Even when law enforcement resources are marshaled, the returns often are small. No more than two dozen doctors, dentists and pharmacists are prosecuted annually for prescription drug offenses, case records show. Most get probation and stay in practice, largely because it is harder to prosecute a professional in a white coat than a street-corner pusher.
In California, about three of four physicians convicted of a prescription drug crime keep their licenses. Users often do more time in jail.
"There are two kinds of justice in this system," said former state narcotics agent Paul K. King, who worked on prescription fraud in Los Angeles County for 10 years. "One for doctors, and one for everybody else."
Take the case of Dr. Eric C. Tucker, whom state narcotics authorities suspected of illegal trafficking after scrutinizing prescription records.
Before his arrest in 1991, court records show, Tucker issued more than 7,000 questionable prescriptions for the stimulant Preludin and another 7,600 for Dilaudid, so-called drugstore heroin, an addictive pain reliever that fetches up to $100 a pill on the street.
More Dilaudid was coming out of Tucker's Montebello office every year than at County-USC Medical Center, the West Coast's largest public hospital.
Tucker, then 59, pleaded guilty to two felony counts of prescription fraud and lost his medical license. Although responsible for flooding the illegal market with hundreds of thousands, if not millions, of dangerous pills, he was sentenced to eight days in jail.
In contrast, Daniel G. Siemianowski, 38, of Los Angeles, a low-level street dealer and first-time offender, was prosecuted about the same time as Tucker. Police arrested him with about four ounces of crack and powder cocaine on the front seat of his car--a speck compared to the doctor's goods. Siemianowski's sentence: a year behind bars.
An Activist Is Born
About 2.6 million people in the United States use prescription painkillers, stimulants, tranquilizers and sedatives for "nonmedical reasons"--more than the estimated use of heroin, crack and cocaine, according to surveys by the National Institute of Drug Abuse. Only marijuana is more popular.
Users run the gamut from street addicts to senior citizens who mix afternoon cocktails of tranquilizers, and even teenagers who sell their doses of Ritalin to classmates.
Some combine prescription drugs with illicit narcotics to enhance the high. Others use tranquilizers to soften the crash from cocaine and heroin, helping them sustain their habits. For many others, pharmaceuticals simply are their drugs of choice.
Sandra K. Bauer, a member of the California Board of Pharmacy, knows how easy it is to fall to prescription drugs--and how complacent regulatory and law enforcement agencies sometimes can be in searching out the truth.