Just days after new research came out with glaring evidence that some physician dispensers are practically thieves, Montana’s Legislature officially introduced legislation that would allow physicians there to dispense medications.

Oh Montana! If you only knew.

If you only knew – that you’re one of the lucky states not at the mercy of these scoundrels and their wily ways. That some 18 states with physician dispensers are jumping through hoops trying to tamp down their underhanded and potentially patient-threatening practices, only to find these crooks can’t be deterred. Pennsylvania was the latest to change its physician-dispensing laws to keep the costs in check, they hope. At least these other states can cling to the fact that they likely didn’t know what they were getting into when they first gave the OK to the idea of docs doling out meds – and their associated costs – from their own offices. But Montana, you have no such excuse.

If you only knew – that a plethora of research raises serious questions about the motivations and intentions of some physician dispensers.

If you only knew – about the clear, new evidence from the Massachusetts-based Workers Compensation Research Institute showing the lengths to which some in this profession would go to circumvent the legislative efforts to rein in physician-dispensing costs and protect patients, at least in two states. For example, where a particular medication is typically dispensed in 5- or 10-milligrams, the researchers found physician dispensers are prescribing and dispensing the same drug in a 7.5 milligram strength that can be assigned a new average wholesale price – at a dramatically higher cost. The study found this to be the case with three medications: hydrocodone-acetaminophen (Vicodin®), cyclobenazaprine HCL (Flexeril®), and Tramadol HCL (Ultram®). It described physician dispensing of cyclobenzaprine HCL in Illinois this way: The average prices paid ranged from $0.99 to $1.74 per pill. The 7.5-milligram products, introduced in 2012, cost an average of $3.79 per pill and almost all were dispensed by physicians. The market share of physician-dispensed cyclobenzaprine HCL of 7.5 milligrams went from 0% in the third quarter of 2012 to 21% in the first quarter of 2013.

The same study showed market share of the physician-dispensed 7.5 milligrams of the drug in California was even more dramatic – going from 0% in the fourth quarter of 2011 to 47% (as in nearly half!) in the first quarter of 2013, “when it became the strength of the drug most commonly dispensed by physicians,” the report said. Where prices for the 5- and 10-milligrams drug in California ranged from $0.35 to $0.71 per pill, the average price paid for the new. 7.5-milligram strength of the drug was $2.90 to $3.45 per pill.

The study found similar results for the other two drugs studied as well. By the end of 2012, the new strength of tramadol HCL (150 milligrams extended release) became one of the most common physician-dispensed drugs in California, with an average price of $5.94 to $7.41 per pill, compared with $1.58 for the same drug of other strengths.

Sadly, it's nearly impossible to find any reason whatsoever for physicians to prescribe alternative strengths of these meds – except to make a whole lot of dough. While it is true that not everyone metabolizes medications in the same way or to the same effect and some may benefit more from the different strengths of the drugs, it’s difficult if not impossible to believe it would be to the extent shown in the study. And, if this is the case, why is it that only physician dispensers are suddenly prescribing these new strengths like they are the greatest thing since sliced bread and other, non-dispensing physicians are not? As the WCRI researchers noted, “because these new-strength drug products were almost all dispensed by physicians at much higher prices, we infer that the shift in strength was unlikely to be driven by new evidence about superior medical practices. Rather, it is likely that financial incentives drove some physicians to choose the strength for their patients.” That’s research-speak for: these people are villainous rats who are willing to go to any lengths to cheat the system.

If you only knew – that based on the overwhelming amount of research, if we were to issue a report card for these physician dispensers, we’d give them an A for cleverness/creativity, and an F- for ethics/morals.

If you only knew – that regardless of our unwillingness to cast aspersions on members of this ‘first-do-no-harm’ profession, not all these folks have the high moral fiber of a Marcus Welby, Dr. Kildare, Dr. Quinn (medicine woman), or even Doogie Howser. 

If you only knew – that the only thing that seems a surefire way to guarantee physician dispensers can’t rob the workers’ comp system blind and not put patients at risk is an outright ban on the practice.

If you only knew all this – you would surely send this proposed legislation and the physician dispensers who endorse it back under the scummy rocks whence they came.