Yes, but he's helped thousands escape chronic daily pain...by killing them.
Medicare’s Opioid Limits Didn’t Protect This Doctor’s Patients From Deadly Overdoses
At least 21 of Dr. Ricky Lockett’s Medicare patients died of overdoses, and he wrote 2,800 opioid prescriptions for those who survived them. ‘I try to be conservative,’ he said.
Dr. Ricky Lockett in his St. Petersburg, Fla., office.
By Mark Maremont, Christopher Weaver, Tom McGinty and Anna Wilde Mathews, WSJ
Aug. 10, 2024 9:00 pm ET
St. PETERSBURG, Fla.—Many who have died of overdoses in this retirement haven in recent years have a common thread. They were Medicare patients of Dr. Ricky Lockett, a local pain specialist.
Lockett is one of the nation’s most prolific prescribers of opioid painkillers to elderly or disabled people covered by the federal program, according to a Wall Street Journal analysis of Medicare data.
At least 21 of his Medicare patients died of drug overdoses between 2017 and 2021, the highest number for any doctor in the U.S., the analysis showed. Scores more survived overdoses. Some of them mixed prescription and street drugs.
Betty Jean Clark, a longtime Lockett patient on Medicare, died of an overdose at age 73. A week before Thanksgiving in 2019, police discovered Clark sitting motionless on a white sofa in her apartment in a senior-living community, wearing jeans and a plaid shirt. Nearby were pill bottles, including methadone prescribed by Lockett. There was evidence of cocaine use.
During the five-year period analyzed by the Journal, Lockett wrote more than 2,800 opioid prescriptions for patients who had previously overdosed, and prescribed the drugs at high doses to hundreds of patients a year, the Journal’s analysis showed.
The private companies that run Medicare’s prescription-drug plans paid for the opioids, even after the overdoses.
“I don’t like it for anyone to die, particularly on my watch,” Lockett said in an interview at his office here. “I try to be conservative. I know that I do.”
Lockett said hospitals rarely tell him when a patient survives an overdose, and patients themselves don’t always volunteer such information. That’s why he sometimes continues prescribing opioids to overdose survivors, he said.
Opioid abuse has mushroomed into a national crisis that thus far has defeated all efforts at a solution. In recent years, Medicare set out to limit the abuse of pain medications, but the controls it put in place proved porous and have failed to stop some doctors from prescribing dangerous amounts.
Betty Jean Clark died of an overdose in 2019. Her daughter holds a photo of Clark and a note she wrote before her death.
Medicare, which now covers about 67 million people, outsources drug benefits for many recipients to a network of private insurers under a program known as Medicare Part D. In 2018, it proposed asking those insurers to impose a daily dosage limit on opioid prescriptions in line with public health recommendations at the time.
But many pain doctors and insurers pushed back, arguing that an abrupt cutoff of high doses could be dangerous for long-term opioid patients and difficult to manage. Insurers didn’t want to have to mediate requests from doctors to make exceptions to the cap for certain patients.
The Medicare agency instead set the maximum daily dosage at more than twice the level it had initially proposed. The cap starting in 2019 was set at 200 morphine milligram equivalents—the amount of narcotic in 20 10-milligram Vicodin tablets, a very high dose for most people. Patients and their doctors could still seek exceptions.
And for the insurers, it was a recommendation rather than a requirement. Only half of Part D drug plans adopted it as of 2022, a spokesman for the Centers for Medicare and Medicaid Services said.
As a result, hundreds of thousands of patients continued to get potentially dangerous opioid dosages exceeding that higher cap, paid for by their Part D drug plans. The Journal analysis showed that 237,713 Medicare recipients got that dose or higher in 2021.
Researchers have found that the risk of overdose rises with dosage. A University of North Carolina study found that the overdose risk is at least 20 times higher at 200 morphine milligram equivalents a day than at 40.
While the total volume of opioids prescribed to Medicare patients has dropped, overdose deaths are more common than ever, the Journal found.
About 13,500 Medicare recipients died from opioid overdoses in 2021, up 40% from 2017, the Journal found. Patients survived roughly 50,000 overdoses in 2021.
After they survive an overdose, many Medicare recipients continue to get painkillers, the Journal found.
More than half of 109,000 active opioid patients who overdosed from 2017 to 2021 were still getting opioids six months later through Medicare drug plans. Most of those were on even higher doses than at the time they overdosed, the data show.
Many of the overdoses are tied to illicit drugs such as black-market fentanyl, but prescription drugs paid for by Medicare insurers play a role. Around three-quarters of Medicare patients who were treated for overdoses had received pain-pill prescriptions at some point during the period analyzed by the Journal, many of them just before their overdoses.
“We still have a massive overprescribing problem, and there are few incentives for plans to care,” said Mark Atalla, a pharmacist and former Medicare official. Many plans will adopt opioid limits, he said, “only to the extent they are required to do it, because it is a cost.”
A Medicare spokesman said fighting the opioid epidemic is a priority. He said the agency’s rules aim to limit inappropriate prescribing while protecting patient access to needed care.
The Journal obtained the Medicare data, which doesn’t include patient names, under a research agreement with the federal government. The data includes information about doctor visits, hospital stays, prescriptions and other medical care patients receive. The Journal identified patients through police reports and medical-examiner records.
In analyzing opioid prescriptions, the Journal excluded drugs given to patients in hospice care or with conditions such as cancer and sickle-cell disease, who aren’t subject to the dosage cap.
Lockett said he knows he is an unusually heavy opioid prescriber. He attributed that to his population of patients, mostly on Medicare, who often come to him with longstanding pain and disability issues, and to his practice’s focus on medication-based pain management.
“I don’t give every individual as much as some docs do,” he said in the office where he sees patients, on the second floor of a 1970s-era medical-office building.
In 2021, Lockett prescribed opioids at or above the suggested Medicare cap to more patients than any other Medicare doctor in the country—409 of them, the Journal analysis found. They represented about two-thirds of his Medicare opioid patients.
He was one of 233 doctors and nurse practitioners who prescribed at or above that threshold to a majority of their Medicare opioid patients that year.
Opioid Shift
After Medicare tried to cap daily opioid doses in 2019, many doctors reduced prescribing. But some, including Dr. Ricky Lockett, continued to exceed the cap for most patients.
Number of patients receiving high daily opioid doses*, by prescriber
Note: Limited to prescribers with at least 500 overall opioid patients and at least 11 with high doses; excludes patients with cancer, hospice care or sickle-cell disease.
Source: WSJ analysis of Medicare data
Lockett said he moderated his prescribing after a 2022 advisory from the Centers for Disease Control and Prevention.
He said he regularly gives urine tests to patients to detect illicit drug use, refers those who fail to a psychologist, and sometimes requires “pill counts”—making patients come in midmonth to check whether they have the appropriate number of pills left.
Even with those precautions, he said, “once we have written the medication, we have no control of how they use it.”
Lockett said he wasn’t aware that Clark, his 73-year-old patient, had died of an overdose. He said he recalled her as a loner, but didn’t remember any problems. She just stopped coming, he said.
Yvette Gaugh, Clark’s daughter, said her mother became addicted after she was prescribed pain medication following an accident.
Rob Valuk, a University of Colorado professor of pharmacy, called the failure to notify doctors of overdoses a systemic problem. He said he’s worked with Colorado officials to develop a system to make such information more available to doctors.
Clark’s daughter, Yvette Gaugh, said her mother became addicted to painkillers after falling off a horse decades ago in Georgia. She later moved to St. Petersburg and began seeing Lockett, her daughter said.
“It was a slow downhill from there,” said Gaugh. Her mother, she said, “was acting all kinds of crazy.”
Clark’s Medicare records, provided by her daughter, show she was getting two painkillers—oxycodone and methadone—in the year before her death, along with a generic form of Xanax, an antianxiety drug that the FDA has warned since 2016 can cause respiratory problems or even death when combined with opioids.
Lockett said he wasn’t aware of public-health warnings about mixing the two types of drugs until 2022, after Clark died.
A spokesman for Humana, the Medicare insurer that covered Clark’s medications, said the company is “committed to help address the opioid epidemic.” He declined to comment on Clark’s case or Lockett’s prescribing, aside from saying that the doctor was no longer in its physician network.
Clark took to selling some of her drugs on the street for cash to buy other drugs, and at one point sold her BMW for drug money, her daughter said. Gaugh said she put her mother into rehabilitation programs three times, but nothing stuck.
She has kept a handwritten note her mother penned during one of her darker drug episodes: “If I make the nite I will change my life back.”
Lockett said many of his patients come to him for help with longstanding pain and disability issues. His office until 2020 faced a highway in St. Petersburg.
Around 2016, Gaugh said, she went with her mother to Lockett’s office to confront the doctor, but his staff wouldn’t let her in. “I wanted to tell him to stop prescribing my mom drugs,” she said. “I didn’t even know how he could prescribe based on the way she was acting.”
Lockett said he didn’t recall Gaugh asking to see him. If she was so worried, why didn’t she try harder, he asked, adding that he welcomes input from people concerned about his patients. “I need all the eyes on these people as I possibly can get,” he said.
An autopsy of Clark found opioids and cocaine in her blood.
“My mother was a normal person until she became addicted,” Gaugh said.
In 2022, Medicare tried to improve treatment for patients with a history of overdosing. It required insurers to monitor the opioid use of many of those patients and consider restricting their access, such as by requiring them to get all their pain pills from a single doctor or pharmacy.
Based on data for that year—for which full information was available for about half of Medicare beneficiaries—the rate at which patients who overdosed and went on to get drugs from multiple doctors or pharmacies declined only slightly.
Lockett, 66, graduated from the University of Pennsylvania and received a medical degree from the Philadelphia College of Osteopathy, according to Florida medical board records. He said he moved into pain management after watching rehab patients struggle to do exercises because of uncontrolled pain.
Lockett said the campaign against prescribing opioids has led some doctors to dial patients back to lower doses too quickly. “We know that a rapid decrease definitely will send them to some type of crisis,” he said.
Other medical experts also said shifting long-term opioid patients too quickly to safer treatments can cause withdrawal or push them to seek illegal narcotics.
“This is a really fraught clinical area,” said Dr. Marc LaRochelle, an addiction expert at Boston Medical Center. “What’s not clear is how to decrease the risk once people have been prescribed those medications.”
Lockett prescribed opioids at or above the suggested Medicare dosage cap to more patients than any other Medicare doctor in the country in 2021.
Until 2020, Lockett operated from a single-story building he owned in St. Petersburg. It faced a highway, across from a nonprofit serving homeless people.
Lockett said he moved to his current office because of the pandemic, citing air-quality issues at his old location. “No one felt safe there,” he said.
Court records show that months before the pandemic, a lender sued to foreclose on that building after Lockett failed to make payments on a loan, and he was later evicted.
Lockett said CVS Health pharmacies stopped filling his opioid prescriptions in November 2022, though he didn’t get a clear explanation. The move came as CVS was entering a roughly $5 billion settlement with state and local governments over its alleged mishandling of pain pills.
CVS’s Medicare drug plans kept covering Lockett’s prescriptions in December 2022, the data show—so long as patients filled them at other pharmacies, including at Walgreens stores. Later, Walgreens drugstores cut him off, too, Lockett said.
CVS declined to comment on any individual doctor. A spokesman said, “any single person overdosing on opioids is too many.”
Medicare drug insurers can block prescriptions from doctors suspected of fraud or other abuses, but otherwise generally are required to cover prescriptions filled at in-network pharmacies for drugs included in their coverage lists, said Xavier Baker, a healthcare lawyer at Groom Law Group.
In Dunedin, Fla., just north of St. Petersburg, sheriff’s officers in June 2021 found the body of a 36-year-old man, Kim Marston, slumped over in his apartment with four needles and an empty bottle of hydromorphone, an opioid painkiller. It was prescribed by Lockett 13 days earlier, and the container originally contained 84 pills, a sheriff’s report said.
An autopsy found fentanyl and Xanax in Marston’s blood, according to a report by the local medical examiner. That medical examiner recorded more than 20 deaths by overdose between 2018 and 2023 of people prescribed drugs by Lockett.
Marston’s mother, Rita Marston, said her son started taking opioids after being injured in a car accident years ago. He became addicted and stopped working, she said, and his personality seemed to change.
“I kind of blamed his doctor,” she said. When she went to his apartment to clean sometimes, she would find opioids and antianxiety medications prescribed by Lockett. “It seems like the doctor just kept doping him up,” she said. “It says take two a day. Christ, my son didn’t take two a day. More like four or six. It became like candy to him.”
Kim Marston’s death was “another one that hurt me,” Lockett said. He said Marston “never came in impaired whatsoever” and didn’t share that he had addiction issues.
Jeri King, a resident of nearby Tampa, said she contacted the Florida health department about Lockett after he kept prescribing opioids and other drugs to a friend even after the friend survived multiple overdoses.
Jeri King said she complained to Florida officials about Lockett. A photo on her phone shows pills she said Lockett prescribed for a friend who previously overdosed repeatedly.
“Please, I am begging you,” she wrote the department late last year. “I’m profoundly concerned that her well-being along with others is in severe jeopardy!” King said in the email, which was reviewed by the Journal.
She said she also called Lockett’s office to warn about her friend overdosing.
Police records show her friend was twice taken to the hospital by paramedics in 2023 after suspected overdoses.
King, 54, a former insurance broker, said her friend kept getting drugs from Lockett. She showed the Journal photos of pill bottles with labels for two opioids—hydromorphone and morphine—prescribed to her friend by Lockett, filled this January and covered by her Medicare drug plan.
A few weeks after her friend received those pills, King said, she found the woman passed out, slumped halfway out of a car. Police records show officers responded to a suspected overdose and involuntarily committed the woman to a hospital.
Lockett said he wasn’t aware of any call from King to his office and wasn’t informed about any overdoses involving her friend.
In a text message to the Journal, the woman denied ever overdosing and asked not to be named. She said of Lockett: “He’s the only doctor I’ve ever met that cares about a person’s pain. Not just making a few bucks.”
Write to Mark Maremont at Mark.Maremont@wsj.com, Christopher Weaver at Christopher.Weaver@wsj.com, Tom McGinty at Tom.McGinty@wsj.com and Anna Wilde Mathews at Anna.Mathews@wsj.com
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