State Suspends Doctor Accused Of Illegally Prescribing Opioids

A Burlington County doctor who is accused of indiscriminately prescribing addictive opioid pain medications to patients has been temporarily barred from treating patients, Attorney General Gurbir S. Grewal and the Division of Consumer Affairs announced on Tuesday.

Dr. Louis Spagnoletti, a pain management specialist in Marlton, is accused of treating patients with high doses of powerful opioids for years without justification, sometimes refilling full-month supplies multiple times a month, according to the complaint filed by the state.

Those powerful opioids included OxyContin, OxyCodone, and three highly-restricted transmucosal immediate release fentanyl – or “TIRF” – drugs that instantly deliver the powerful painkiller fentanyl through the oral membranes, according to the state.

“TIRF” drugs are sold under the brand names “Subsys,” “Actiq,” and “Fentora.” They are approved only to treat breakthrough pain in cancer patients who are already receiving – and are tolerant to - around-the-clock opioid therapy for pain. Spagnoletti prescribed the drugs to three patients who did not meet that criteria, according to the state.

As part of a consent order, Spagnoletti agreed to stop seeing patients and surrender his New Jersey CDS Registration that had allowed him to prescribe narcotics and other controlled substances, pending a full hearing in the Office of Administrative Law, and pending further action by the Board.

“It is unconscionable that a doctor would fail to address the underlying causes of pain and simply prescribe his patients ever-escalating quantities of opioids that mask their symptoms and put them at risk of becoming addicted,” Grewal said. “Doctors who engage in this kind of indiscriminate prescribing not only deprive their patients of possible alternative treatments and solutions to pain, they directly contribute to New Jersey’s opioid addiction crisis. Their actions will not be tolerated.”

The complaint focuses on Spagnoletti’s treatment of seven patients during various periods between September 2005 and July 2017. He is accused of:

• Prescribing patients pain medication for years without identifying or treating the root causes of their pain, and without formulating coherent treatment plans with objective goals for managing it;
• Prescribing opioids and other CDS without discussing with patients the risks associated with the habit-forming drugs;
• Routinely refilling prescriptions early and exceeding dosage limits on opioids and other CDS; and
• Ignoring signs that patients may be misusing, diverting, and/or addicted to the drugs, such as when patients obtained multiple prescriptions for the same drugs from different doctors and/or when patients’ urine drug screens were negative for the CDS prescribed and/or positive for illicit substances or CDS that was not prescribed.

The complaint, which identifies the patients by their initials, alleges that during the course of treatment Spagnoletti:

• Routinely prescribed full-month supplies of large quantities of Dilaudid, Oxycodone, and OxyContin only weeks apart to patient M.P. despite assessing him to be at “high-risk for opiate abuse”;

• Prescribed Actiq and Fentora to patient J.W., who did not have cancer. Saw J.W. one-to-two times a week for medication refills intended to last an entire month, including fentanyl patches and Actiq;

• Prescribed large quantities of Oxycodone, OxyContin, Amrix, Valium and other CDS to patient M.S despite the fact that she suffered severe side effects that included fatigue, forgetfulness, and poor short-term memory;

• Prescribed Subsys to A.P., who did not have cancer, and continued to overprescribe Subsys, OxyContin, and Oxycodone as treatment for patient A.P.’s chronic pain;

• Prescribed Actiq to patient T.U., who did not have cancer. Continued to over-prescribe OxyContin, and Morphine to T.U. for more than six years after the patient expressed a desire to quit taking pain pills and enter a detox center;

• Continued to over-prescribe Fentora, hydrocodone, and morphine to patient M.O. despite signs the patient may have been diverting the drugs. For example, on five occasions, M.O.’s urine drug screen failed to show the presence of fentanyl (Fentora), and on three other occasions failed to show the presence of hydrocodone, fentanyl, and morphine, despite the fact that the doctor had prescribed those drugs to him; and

• Failed to try alternative methodologies of treating patient C.C.’s pain; only offering her opioids despite the fact that C.C.’s pain levels remained steady for more than a year while being treated with multiple medications at increasing levels.

The state filed its complaint on June 29, 2017. Spagnoletti had been prohibited from practicing medicine since Aug. 3, under interim consent orders with the Board.

In March, his license was reinstated as part of an agreement that he will refrain from all clinical practice until his case is heard by an Administrative Law Judge, and pending further action by the Board. Under the terms of the Consent Order, Spagnoletti may not enter any medical office when patients may be present, and must obtain prior Board approval before engaging in any non-clinical medical employment.

Patch file photo