NEWARK – Attorney General Gurbir S. Grewal and the Division of Consumer Affairs announced today that a Middlesex County doctor has been temporarily suspended from practice after a review of the New Jersey Prescription Monitoring Program (“PMP”) revealed that over the past year he prescribed more than 150,000 units of the most powerful opioid pain medication, with 80 percent of his prescriptions providing patients with daily morphine levels that exceeded limits recommended by the Centers for Disease Control and Prevention (“CDC”.)
Dr. Eddie Gamao, a general practitioner in Piscataway, agreed to temporarily surrender his license to the state Board of Medical Examiners (“the Board”) amid allegations he indiscriminately prescribed highly addictive opioids in excessive amounts and dosages, to his patients between February 2017 and February 2018.
The 77-year-old physician’s prescribing habits came under scrutiny after a pharmacist filed a complaint on the PMP’s Suspicious Activity Report (“SAR”) online portal alleging Gamao may have been indiscriminately prescribing controlled dangerous substances (“CDS”) to three generations of a South Plainfield family, including an 88-year-old grandmother.
A review of Gamao’s prescribing history on the PMP revealed that during a 12-month period, he prescribed more than 9,000 oxycodone pain pills in the strongest available dosages to the elderly woman, her son, and daughter-in-law in dosages that more than tripled the CDC’s recommended daily morphine milligram equivalents (“MME”) limits for each person. Gamao also prescribed more than 1,000 units of powerful opioid painkillers to the elderly woman’s two adult grandchildren in dosages that met or exceeded MME limits.
The temporary suspension of Gamao’s license marks the first time a physician’s practicing authority has been restricted as a result of allegations that were reported on the SAR portal and substantiated via a review of PMP records, including MME data.
“One tip from an alert pharmacist on our SAR portal, followed by an analysis of our PMP records, was all we needed to identify and shut down this dangerous operation. This doctor was prescribing highly addictive opioids at a rate that simply had no medical justification,” said Attorney General Grewal. “This case not only illustrates the vital role pharmacists play in New Jersey’s fight to end opioid addiction, it also shows that we are starting to see success with the tools we've put in place to stem the flow of improperly prescribed opioids. We will keep using these tools until we can bring this public health crisis to an end."
In addition temporarily surrendering his medical license, Gamao has agreed to temporarily surrender his NJ CDS registration that allows him to prescribed controlled substances in the state.
“A review of Dr. Gamao’s entire prescribing history on the PMP revealed that his alleged indiscriminate prescribing of opioids was not limited to the family in question, it spread across his entire patient base,” said Kevin Jespersen, Acting Director for the Division of Consumer Affairs. “To ensure the safety of the public, the Board has acted appropriately to cut off this dangerous flow of opioids and ensure that Dr. Gamao will have no access to a prescription pad until these very serious allegations against him are addressed.”
Gamao’s prescribing records showed that during a 12-month period he prescribed highly restricted “Schedule II” opioids like oxycodone, morphine, and fentanyl to 106 patients. An analysis of the prescribing data revealed that:
- More than half of all the 1,040 Schedule II opioid prescriptions Gamao wrote resulted in daily MMEs of 270 or higher – at least triple the CDC’s recommended limit.
- Nearly 99 percent of the 639 prescriptions Gamao wrote for oxycodone immediate-release prescriptions resulted in daily MMEs that exceeded the CDC’s recommended limit.
- In the case of the 88-year-old woman, Gamao routinely prescribed high-quantity, high-dosage opioid prescriptions for 30mg oxycodone days apart from one another, which resulted in a combined daily MME of 810 – nine times the CDC’s recommended limit.
- Maintained some patients on morphine levels that ranged from 330 to 960 daily MMEs.
Under the terms of a Consent Order with the Board, Gamao’s medical license will remain suspended until further action by the Board and his NJ CDS Registration will remain suspended until further order of the Director of Consumer Affairs. Under the terms of the agreement, Gamao may apply to the Board and/or the Director to request a hearing for modification of the Order.
The SAR portal and the PMP’s automatic MME conversion program are among the latest expansions to New Jersey’s PMP, a database aimed at identifying problem-prescribers.
The SAR portal allows pharmacists and members of the public to report suspicious activities such as the overprescribing of controlled dangerous substances (“CDS”), “doctor shopping” to stockpile drugs, or the circulation of forged or stolen prescriptions.
The MME conversion program automatically converts opioid dosage measurements into a standard value to help prevent overdoses and over prescribing. The PMP automatically converts dosages of commonly-prescribed opioids of differing potency, such as codeine, fentanyl, and oxycodone, into a standard value known as "morphine milligram equivalents" (MME). This conversion allows prescribers to compare the total potency of different opioid medications a patient is consuming with CDC guidelines which advises prescribers to use extra precautions when increasing patients to 50 MME per day and avoid or carefully justify increasing a dosage to 90 MME per day.
Last month Attorney General Grewal announced that the NJ PMP’s role as a vital addiction-fighting tool will be expanded further under a series of upgrades and enhancements to the program that uses an electronic database to track information on prescription sales of narcotic painkillers and other habit-forming drugs. Proposed enhancements include adding the anticonvulsant medication Gabapentin, a drug known to enhance the effects of opioids, to the list of drugs tracked by the NJ PMP; expanding access to the NJ PMP database to certain mental health providers; and hiring a medical consultant to assist in reviewing NJ PMP data to identify and flag potential cases of problem prescribing and to assist the development of advanced data-analysis programs to identify abnormal prescribing patterns.
Deputy Attorney General David M. Puteska, Assistant Section Chief of the Professional Boards Prosecution Section in the Division of Law, is representing the State in this matter.
For more information visit the Division’s NJPMP website at www.NJConsumerAffairs.gov/pmp.
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