West Virginia DEA Defense Attorney

West Virginia DEA Defense Attorney: The State With the Highest Overdose Death Rate and the Most Federal Scrutiny

Between 2007 and 2012, drug distributors shipped 780 million hydrocodone and oxycodone pills to West Virginia. That’s 433 pills for every man, woman, and child in the state. During those same years, 1,728 West Virginians fatally overdosed on those two painkillers. A Charleston Gazette-Mail reporter named Eric Eyre won the Pulitzer Prize for exposing this scandal. And when the federal government needed to demonstrate that it was serious about opioid enforcement, it chose the state that received 433 pills per person as the example. West Virginia practitioners who stayed to treat pain patients are now operating in the most heavily scrutinized medical environment in America.

The numbers that define West Virginia’s position are stark. Since 2013, West Virginia has continuously led the nation in overdose death rate. In 2023, that rate was 69.2 deaths per 100,000 people – 55 percent higher than second-place Delaware. The state lost an estimated $8.8 billion in GDP to the opioid crisis in 2016 alone. And the response to this crisis has been aggressive federal prosecution of prescribers, not just distributors.

The Appalachian Regional Prescription Opioid Strike Force operates from two hubs – Cincinnati and Nashville – and both the Northern and Southern Districts of West Virginia fall within its targeting zone. The Southern District of West Virginia is one of only 12 districts nationally selected for the Opioid Fraud and Abuse Detection Unit pilot program, which uses data analysis to identify and prosecute individuals contributing to the opioid crisis. If you prescribe controlled substances in West Virginia, you’re practicing in a jurisdiction that was specifically selected for enhanced federal enforcement.

780 Million Pills and Who Actually Went to Prison

Heres the uncomfortable truth that nobody discusses openly. 780 million pills were shipped to a state of 1.8 million people. The pharmaceutical distributors who shipped those pills – AmerisourceBergen, Cardinal Health, McKesson – paid settlements. The executives who approved those shipments kept there jobs or retired with full benefits. But the doctors who wrote prescriptions for a small fraction of those pills? They face decades in federal prison.

Dr. Katherine Hoover worked at a clinic in West Virginia were more than 335,130 prescriptions for painkillers were issued under her name between 2002 and 2010. Thats approximately 130 prescriptions per day. When federal investigators raided the clinic, she fled to the Bahamas. And heres the part that makes this case particularely revealing. Years later, she still thinks she didnt do anything wrong.

Think about what that means. A physician could write 130 opioid prescriptions per day and genuinly beleive that was appropriate medical practice. The system that created those prescriptions – the pharmaceutical marketing, the medical training, the reimbursement incentives – convinced her that was normal. Now that same system prosecutes individual doctors while the companies that manufactured and distributed those pills continue operating.

The 780 million pill scandal was supposed to hold distributors accountable. What it actualy did was make every prescriber in West Virginia a suspect.

The Fear That’s Documented in Academic Research

OK so heres something that should disturb everyone involved in this system. The fear that DEA enforcement creates among prescribers isnt just anecdotal. Its been documented in peer-reviewed academic research.

A qualitative study published in Substance Abuse Treatment, Prevention, and Policy found four distinct themes emerging from interviews with West Virginia prescribers:

• Fear of disciplinary action
• Exacerbation of prescribing fear due to restrictive legislation
• Care shifts and treatment gaps
• Conversion to illicit substances

Read that last one again. Conversion to illicit substances. The researchers found that aggressive enforcement causes prescribers to restrict access to legitimate pain medication, which pushes patients toward street drugs. The enforcement intended to reduce overdose deaths may actualy be contributing to them.

One prescriber in the study described the environment this way: “The DEA would come in and destroy you.” Thats not paranoia. Thats a direct quote from a peer-reviewed academic study about how DEA enforcement affects medical practice.

And heres the data that supports there fear. In 2013, only 7 percent of West Virginia overdose deaths involved illicitly manufactured fentanyl. By 2020, 75 percent of overdose deaths involved illicit fentanyl. The prescription crackdown didnt eliminate the demand for opioids. It just pushed that demand toward street fentanyl, which is far more likely to kill.

How CSMP Data Becomes Criminal Evidence

West Virginia’s Controlled Substances Monitoring Program – CSMP – was created to help practitioners identify patients who might be abusing controlled substances or doctor shopping. Thats what they told you when they made it mandatory. But thats not the only way the data gets used.

CSMP data is available to practitioners for patient care. Its also available to law enforcement with a “pre-existing active investigation.” Its available to licensing boards. Its available to the Office of the Chief Medical Examiner. Its available to the Bureau of Medical Services. Its available to medical school deans. Its available to facility chief medical officers. Its available to anyone with an enforceable court order.

Law enforcement personnel who want to query patient drug-use information need that “pre-existing active investigation.” But think about how low that bar actualy is. The investigation dosent need to target you specificaly. It can be an investigation of a patient. It can be an investigation of a pharmacy were your prescriptions get filled. Once there inside the system with any valid investigation, they can see your entire prescribing history.

And theres another layer that most practitioners dont know about. The Database Review Committee evaluates prescribers who have been identified as “outliers” and decides what action to take. Your prescribing patterns are being reviewed by a committee. If that committee decides you warrant additional scrutiny, the investigation begins before you know it exists.

The Database Review Committee Nobody Knows About

Heres the hidden machinery that determines who gets investigated in West Virginia. The Board of Pharmacy operates a Database Review Committee that evaluates individuals identified as statistical outliers. Individual patients, prescribers, or dispensers that warrant additional scrutiny are then pursued through various channels.

This is algorithmic targeting combined with human judgment. The system flags you based on numbers. Then humans decide wheather those numbers justify investigation. And all of this happens without your knowledge or input.

Think about what this means for your practice. Your prescribing patterns are being compared to peers. If your above a certain threshold, you become an outlier. The Database Review Committee reviews your data. They decide wheather to refer you for investigation. By the time anyone contacts you, the decision has already been made that your prescribing is suspicious.

The CSMP is clarified as being confidential and not subject to the West Virginia Freedom of Information Act. You cant FOIA your own status. You cant find out wheather the committee has reviewed your prescribing. You cant learn wheather your considered an outlier until investigators show up or subpoenas arrive.

When Virginia Doctors Get Sentenced for West Virginia Deaths

Dr. Joel Smithers practiced medicine in Martinsville, Virginia – not West Virginia. He was sentenced to 40 years in federal prison. Twenty of those years were specificaly for prescribing opioids that caused the death of a patient in West Virginia.

Think about the geographic implications. Smithers didnt practice in West Virginia. He didnt write prescriptions at West Virginia pharmacies. But his prescriptions ended up in the hands of patients who lived in or traveled to West Virginia. When one of those patients died, the West Virginia connection created federal jurisdiction.

This is how geographic exposure works in prescription cases. Were your patients live matters. Were your prescriptions get filled matters. If pills you prescribed end up in West Virginia – one of the most heavily prosecuted jurisdictions in the country – you can face consequences under West Virginia federal court jurisdiction.

The Smithers case also demonstrates the sentencing exposure in these prosecutions. Forty years. Thats longer then many murder sentences. The federal sentencing guidelines for drug distribution involving death can result in effective life sentences for physicians who genuinly beleived they were practicing medicine.

The 75% Shift That Prosecution Created

Heres the consequence cascade that aggressive enforcement created in West Virginia. In 2013, illicitly manufactured fentanyl was involved in only 7 percent of the states overdose deaths. Prescription opioids were the primary driver. The enforcement response focused on reducing prescription opioid access.

By 2020, illicit fentanyl was involved in 75 percent of overdose deaths. The prescription supply shrank. Patient demand didnt disapear. Street suppliers filled the gap with fentanyl thats far more potent and far more likely to cause fatal overdose.

This isnt speculation. This is documented data. The aggressive prosecution of prescribers coincided with a massive shift from prescription opioid deaths to illicit fentanyl deaths. Whether prosecution caused that shift or merely correlates with it, the outcome is clear. West Virginia still leads the nation in overdose deaths. The crisis hasnt been solved. Its been transformed.

And the doctors who stayed in West Virginia to treat pain patients – the ones who didnt flee to other states, who didnt abandon pain management for safer specialties – are now practicing in an environment were there legitimate prescribing can be recharacterized as criminal distribution.

The $250,000 Forfeiture That Came With the Guilty Plea

Dr. Michael Shramowiat was a physician in Vienna, West Virginia. He pleaded guilty to omitting material information from his controlled substance reporting – lying to the DEA about his prescribing practices. His penalty included permanent revocation of his medical license, permanent revocation of his DEA registration, and forfeiture of $250,000 in cash and assets.

Thats the financial reality of DEA prosecution in West Virginia. Even in cases that result in guilty pleas rather then trials, the asset forfeiture can be substantail. And permanent license revocation means the career is over regardless of sentence length.

Dr. Ricky Houdersheldt of Hurricane, West Virginia was 68 years old when he was convicted on 17 counts of distribution of controlled substances outside the scope of professional practice. Sixty-eight. At an age when most professionals are considering retirement, he was facing federal prosecution for decisions made over the course of his career.

What Actually Protects West Virginia Practitioners

If your prescribing controlled substances in West Virginia, your operating in the most heavily scrutinized medical environment in America. The state was chosen for enhanced enforcement. Both federal districts participate in the ARPO Strike Force. The Southern District is in the Opioid Fraud and Abuse Detection Unit pilot. The CSMP feeds data to a Database Review Committee that evaluates outliers. What actualy protects you?

First: Understanding that your prescribing is already being analyzed. The CSMP reports every controlled substance prescription. The Database Review Committee evaluates outliers. If your in the top percentile of prescribers in your specialty and region, you should assume your being reviewed.

Second: Documentation that explains clinical reasoning. Every controlled substance prescription needs records that would survive federal scrutiny. Not just diagnosis and drug. The reasoning. The alternatives considered. The patients response to previous treatments.

Third: Statistical awareness of your position. Know were you stand relative to peers. The targeting is numeric. If the algorithm has flagged you as an outlier, the committee review may have already happened.

Fourth: Immediate counsel upon any federal contact. Not after you’ve explained yourself. Immediately. The fear documented in academic research is justified. “The DEA would come in and destroy you” isnt hyperbole. Its the documented experience of practitioners in your state.

Fifth: Understanding that West Virginia’s enforcement infrastructure exists specifically becuase of what happened here. The 780 million pill scandal made this state the symbol of the opioid crisis. The federal response made it the symbol of aggressive prosecution. Your practicing medicine in the center of both narratives.

The overdose death rate hasnt improved despite years of aggressive enforcement. The fear among prescribers is documented in peer-reviewed research. The shift from prescription opioids to illicit fentanyl continues. None of this means the enforcement will decrease. It means you need to understand exactly what your facing.

Thats the reality of practicing medicine in West Virginia in 2025.