Jodi Barber wasn’t sure what might happen as she drove north from her Laguna Niguel home to see a doctor in Rowland Heights in December 2010. The drive is just a short run up the 57 Freeway, and then just four exits west on the 60. But from Barber’s perspective, too many had driven to visit the same doctor at her clinic in Diamond Plaza, a sparkling, two-story minimall that also hosts a dentist’s office, a seafood restaurant, a Charles Schwab brokerage, and an athletic footwear store.
Barber wasn’t seeing Dr. Hsiu-Ying “Lisa” Tseng for treatment. Nearly a year before, Barber’s 19-year-old son, Jarrod, had died after swallowing a cocktail of three prescription drugs that included Opana, a narcotic painkiller sometimes used to ease the pain of cancer patients.
He had prescriptions for the other two—Seroquel, an antipsychotic, and Clonazepam, an anticonvulsant often used to treat anxiety. Based on her own investigation, Barber believed the Opana had come from one of Jarrod’s friends, who’d obtained a prescription for it from Tseng.
That friend, 20-year-old Riley Russo, had died of an overdose only days before Barber headed for Tseng’s clinic. He had taken Opana and other drugs prescribed by Tseng, and Barber wanted to know why Russo and other Orange County teens and young adults had been able to obtain prescriptions from Tseng to feed their cravings, why a physician who’d taken the Hippocratic Oath to “do no harm” had become known among addicts for operating a pill mill, why South County kids were driving 45 miles to see her, turning the 57 Freeway into an expressway to addiction. “I just wanted answers,” Barber says.
Arriving at the clinic, she told Tseng’s receptionist she wanted to discuss a billing problem with the doctor. As a patient came out into the waiting room, she sprang from her chair and walked into the consulting room, where Tseng, a bespectacled, somewhat rumpled woman, sat in her lab coat.
Barber had brought six prescriptions for painkillers she had collected from the mothers of other O.C. addicts. “Do you see these scrips?” she asked the doctor. “This is all from you in one week. Why would you prescribe deadly combinations and Opana? Do these kids look like they have cancer?”
Tseng sat impassively with a blank expression, Barber says. “She just looked at me and said, ‘No comment.’”
The one-sided confrontation continued. “I realize it’s the kids’ choice, but you’re the professional and you know better.” Still no response. Then Barber brought up the very personal reason she’d come to see Tseng: “My son overdosed and died with Opana in his system that came from you.” Still Tseng displayed no emotion. Then, finally, she said: “It’s not my fault. It’s the parents’ fault.”
Barber wasn’t going to let Tseng have the last word: “No, you’re the professional. You know how addictive Opana is. You see them over and over. You make a lot of money this way. It was his friends that came to you.”
About 15 months later—on March 1, 2012—Los Angeles County sheriff’s deputies and California Medical Board investigators paid a visit of their own to the clinic, and led Tseng away in handcuffs. She has been in the county jail ever since, in lieu of $3 million bail, charged with second-degree murder in the prescription drug overdose deaths of three young men, one of whom—Vu Nguyen, 28—was from Orange County. A 2010 investigation by the Los Angeles Times linked her to at least five other deaths.“Prescription drug overdose deaths have reached epidemic proportions,” Los Angeles County District Attorney Steve Cooley said in announcing Tseng’s arrest. “Enough is enough. Doctors are not above the law.”
If convicted at a trial that may be held later this year, 42-year-old Tseng could face 45 years to life in prison. Barber and other mothers of Orange County prescription drug overdose victims have attended pretrial hearings in downtown Los Angeles, expressing their solidarity by wearing red T-shirts emblazoned with “Pills Can Kill.”
But fatal overdoses continue to mount. Orange County coroner records show that those involving teens and young adults more than doubled from 130 in 2003 to 266 in 2009; Barber has documented 24 deaths in South County alone. Other doctors throughout Southern California have been accused of wrongfully prescribing or overprescribing drugs. They include Dr. Julio Diaz of Santa Barbara, who allegedly accepted sexual favors as payment for narcotics from some female patients, and Dr. Rolando Atiga of Glendora, who was arrested during a police sting operation last July. But the Tseng case has attracted worldwide attention, in large part because charging a physician with murder in the death of a patient is extremely rare. Parents of overdose victims hope the upcoming legal proceedings will reveal how their children succumbed to prescription drug addiction and how the medical profession, instead of being part of the solution to a public health crisis, may be part of the problem.
In the living room of her Laguna Niguel home, Jodi Barber is joined by two other parents—James Kennedy of San Clemente, and Laurie of Huntington Beach, who asked that she be identified only by her first name. Articulate and thoughtful, they’re united in the unfathomable pain of losing their children to addiction, or worse. Their losses are part of a gruesome nationwide phenomenon of deaths from prescription drug overdoses, which now kill more people than heroin and cocaine combined and have doubled drug-related deaths in the U.S. during the last decade.
Painkillers are the most commonly abused prescription drugs among teens, with approximately 10 percent reporting use at least once in their lifetime, according to a 2008 national research study. In the 2008 California Healthy Kids Survey, compiled by the state Department of Education, 17 percent of Orange County 11th-graders reported usage at least once in their lives.
Kennedy’s 28-year-old son, Joey, was partying with friends when he died of what the coroner’s office called “acute polydrug intoxication,” mostly Xanax, an antianxiety drug, and methadone. Both drugs were prescribed by the same San Clemente doctor. Afraid of being arrested, Joey’s friends drove past at least four hospitals before dumping him on the side of a road in San Juan Capistrano, where his body was found on the morning of Feb. 4, 2010. Kennedy recalls his son as “a great kid … handsome, athletic, intelligent, creative, artistic. And he got hooked.” Joey, he says, had a “real desire to get sober. It was just that the disease [of addiction] was more powerful.”
Laurie’s son, now 27, survived an overdose of Roxicodone, a brand of oxycodone, and Soma, a muscle relaxant, last July 18. His anguished mother says he injects painkillers after crushing and then liquefying the pills to get a more rapid and powerful high. Since his overdose, she has barred him from her house until he gets clean. “I know he wants it,” she says. “But I also know the power of addiction.” Laurie has brought with her a Ziploc bag filled with prescription drug bottles she confiscated from her son between April and July of last year. One bottle contains 120 30-milligram pills, a 30-day supply of oxycodone. The pharmacy label on the bottle is dated the day before her son overdosed.
The contents of the Ziploc bag, which also include Soma, Opana, and a hydrocodone variant called Norco, illustrate an uncomfortable truth. The drugs Laurie’s son abuses are not the clumsily packaged product of an illicit meth lab or the off-white “rocks” pushed by a crack cocaine dealer on the streets. They are the innocuous-looking product of pharmaceutical companies that have invested billions of dollars to create synthetic derivatives of opium known as “opioids.” Miracles of modern science, opioids were developed to relieve pain from cancer and other severe conditions by mimicking the body’s natural painkillers, the neurotransmitters called endorphins. Opioids legally are available through a prescribing physician, and prescriptions can be filled at a drugstore. As with opium and morphine, opioids produce a surge of euphoria. Addicts have an uncontrollable craving for that euphoria. According to Physicians for Responsible Opioid Prescribing, more than 25 percent of opioid users meet the criteria for addiction.
During an opioid overdose, the victim suffers respiratory depression as the drug interferes with the breathing signal from the brain; the breath rate often drops to less than 12 a minute. Pupils shrink to pinpoints, followed by drowsiness, nausea, and vomiting. Death follows a shutdown of the central nervous system.
The demand for painkillers has been insatiable, particularly in the U.S. (See “The Rise of Opioids,” below.) “We have become a nation of pill poppers,” lamented Fortune magazine in a November 2011 posting on its website.
Amid this frenzy of pharmaceutical consumption, physicians are supposed to act as gatekeepers who only prescribe drugs to patients with a legitimate medical need. But what happens if a physician abuses the power to prescribe?
Lisa Tseng, who was licensed in 1997 as an osteopathic physician and surgeon, operated her clinic with her husband, Gene Tu, a medical doctor. Osteopathic medicine once was regarded as a fringe of the medical profession, but individuals who obtain a D.O. undergo essentially the same training as M.D.s. The couple called their practice Advanced Care AAA Medical.
Tseng has denied any wrongdoing. “I never intended to kill anybody,” she told the Los Angeles Times in 2010. “I really believe I did nothing wrong. I was really strict with my patients, and I followed guidelines. If one of my patients decides to take a month’s supply in a day, then there is nothing I can do about that.”
At a preliminary hearing, Tseng’s attorneys argued that her patients who overdosed were responsible for their own deaths. But evidence presented at the hearing, several wrongful-death lawsuits filed against her by patients’ relatives (some in Orange County), and malpractice allegations brought by the Osteopathic Medical Board of California paint a picture of Tseng as a rogue physician who practically turned her clinic into a vending machine for addicts.
“I was in and out in five minutes” with prescriptions for OxyCotin, Norco, and Xanax recalls Dimitri, a Dana Point resident and recovering addict who visited Tseng in November 2008. Dimitri, who asked that his last name not be used, heard about Tseng from another addict. “People from San Diego and Arizona all knew Dr. Tseng,” he says. “She was well-known.” The clinic’s waiting room “was full … all twentysomethings, white 20-year-olds, seemingly in perfect health.” The visit cost him $300, which he paid in cash before leaving.
In its accusation against Tseng, the osteopathic medical board listed Dimitri as one of 14 patients whom the doctor had treated with gross negligence. According to Tseng’s records, Dimitri told her he had anxiety and lower-back pain, but the board said she performed an “inadequate” physical exam and never asked him whether he had a history of alcohol and drug use to see if he was an addict.
“Had she questioned her patient, [he] might have actually disclosed a significant piece of medical history, because he was in an emergency room for intoxication and drug overdose merely six weeks earlier,” the board concluded. “This was a critical oversight, since prescription drug abuse is highly prevalent in young adult males.”
Laurie, the Huntington Beach mother, says her son had a similar experience after he began visiting Tseng in 2008: “My son said … he would just walk in, he’d give her the money, she’d write the scrip, and he’d be out.” When her son entered rehab in January 2009, he gave her several bottles of pills prescribed by Tseng. She remembers flushing at least 100 Somas down the toilet.
Tseng surrendered her medical license Feb. 29, 2012—the day before she was arrested—without contesting the osteopathic medical board’s allegations, and she settled the wrongful-death suits. In June, a Los Angeles Superior Court judge ruled that she could be tried for murder in the deaths of 21-year-old Joseph Rovero, 24-year-old Steven Ogle, and Lake Forest’s Nguyen, who died in March 2009 of an overdose attributed to Opana and Xanax. Opana has become increasingly popular among addicts since Purdue Pharma made OxyContin crush-resistant. Judge M.L. Villar de Longoria said Tseng “improperly used her prescription pad to cause irreparable harm.”
Jodi Barber felt vindication and horror while attending Tseng’s preliminary hearing. “I was so relieved that she was sitting there in that [orange jail] suit. … It was also sickening to see her face again because the last time I saw her was in her office. I was just so thankful that she was sitting there.” If Tseng is convicted, Barber says, “I think it will scare some doctors. Even if it scares one, that would be good.”
After his one visit to Tseng, Dimitri, the recovering Dana Point addict, says he found several doctors in Orange County to feed his habit. “They were closer and gave out more pills,” he says, adding that he went to a doctor a week. Where Tseng prescribed 60 pills, others prescribed 90 and, in one case, 120. He believes physicians “should be held to a higher standard.”
“The people who are going to the doctor [for pills] are already sick,” says James Kennedy, who lost son Joey to an overdose. “They have a deadly disease called addiction. Instead of trying to treat them or referring them to somebody who can help them, they [give them more pills].”
Of course, the problem of prescription drug abuse goes deeper than rogue doctors. Dimitri blames his addiction in large part on “certain characteristics” of his personality such as “a sense of entitlement” and “arrogant thinking.” The pills had a “calming effect,” he says. But he also says teens and young adults don’t know what they’re getting into with prescription drugs. “This generation is a lot less educated. … They don’t realize what they’re taking.”
Dimitri’s instincts are borne out by research. (See “What Teens Believe,” below.) Parents, too, need to be educated about the dangers of prescription drugs. In a study by the federal Substance Abuse and Mental Health Services Administration, only one in four teens reported discussing prescription drug abuse with parents. Twelve- to 17-year-olds whose parents express strong disapproval of drug use are far less likely to engage in substance abuse, according to the agency.
“Once you know what to look for, it’s very easy to tell when somebody’s on opiates,” Laurie says. “They’re nodding off, slurring. I could tell the second my son walked in the house. … I think parents need to pay closer attention to their kids and look for those signs.”
Since her son’s fatal overdose three years ago, Barber has become an activist, focusing on prescription drug abuse education. Among other things, she co-produced the documentary “Overtaken,” (watch it here) which features about a dozen South County students talking about their addictions. One girl says she overdosed multiple times and ended up in rehab at 14. It didn’t work, the girl infers in the film: “Ultimately, I got hooked on heroin.” The film also features Aaron Rubin, a standout athlete at Poway High School in San Diego County, who spent three weeks in a coma and is now a quadriplegic after overdosing on Oxycontin at 27. “I made [the documentary] because kids listen to other kids talk,” Barber explains. Whenever she can, she tells parents to educate themselves. “A lot of them still don’t know about Opana.”
Another documentary, “Behind the Orange Curtain,” was conceived by Natalie Costa, who, after taking her daughter to the funeral of a 17-year-old overdose victim, began wondering why so many Orange County kids were abusing prescription drugs. Costa blamed the problem in part on the county’s affluence—kids are left to their own devices by working parents, and have the expendable income to buy drugs or insurance that covers the cost of pain medication. “I think a lot of parents think, ‘It’s not going to happen to my child. We live here in beautiful Orange County,’ ” says Laurie, the Huntington Beach mother.
Echoes Barber: “I go to their houses in Newport Beach—gorgeous, 10,000-square-foot homes. Beautiful blond girls with everything going for them, and they’re addicted.”
Barber’s educational materials also include a poster she created with photos of 24 South County children, including her dead son and his dead friend Riley Russo. The youngest is 15-year-old Nolan Smith, whose older brother was a patient of Lisa Tseng’s. And Barber bears a personal testament to the devastation wrought by prescription drugs. She extends her forearm, revealing a tattoo of Jarrod’s face that she got shortly after he died.
“It hurt,” she says, “but it was worth it.”
THE RISE OF OPIOIDS
Prescriptions in the U.S. for drugs including Vicodin and OxyContin, a brand name for oxycodone, the top-selling opioid:
in 1991: 40 million
in 2007: 180 million
$3.1 billion OxyContin revenue generated for its manufacturer, Purdue Pharma, in 2010
WHAT TEENS BELIEVE
41% Prescription drugs are “much safer” than illegal drugs
32% Painkillers have fewer side effects than street drugs
52% Abusing these medicines is not dangerous
SOURCE: A 2008 study by the federal Substance Abuse and Mental Health Services Administration
Where to Get Help
Hope interventions 714-457-4839
Teen Challenge 714-835-8822
Embrace Recovery Outpatient Program 949-525-9969
Wellminded Center 949-521-6890
Kim Quickel Family Practice and Addiction Counseling 949-232-4134
You can watch parent Jodi Barber’s documentary “Overtaken”
A documentary by parent Jodi Barber
To purchase a print or digital copy of the March 2013 issue, click here.