A doctor specializing in addiction told a jury Tuesday that those who crave prescription narcotics speak of "the holy trinity."
Testifying in the trial of Stephen and Linda Schneider, Cleveland physician Ted Parran said prescription drug addicts seek a specific mixture of three drugs to fulfill cravings:
* A narcotic pain reliever, preferably an opiate such as hydrocodone, found in Lortab or Vicodin.
* An anti-anxiety drug, such as a benzodiazepine from a Valium or Xanax.
* A muscle relaxant such as carisoprodol, found in Soma.
It's the same combination patients received regularly at the Schneider Medical Clinic in Haysville, Parran testified.
After studying some 150 medical records from the clinic, Parran said he found many patients who were prescribed Lortab on the first visit.
Parran found little evidence that Stephen Schneider, the doctor; his wife, Linda, a licensed practical nurse who managed the clinic; or providers who worked for them asked questions about what ailed the patients.
Records showed a lack of medical history, Parran testified, and blank spaces on drug assessment and pain management forms.
"It was very common the patients were prescribed what they asked for," said Parran, a clinical associate professor of the medical school at Case Western Reserve.
"In that case, who is the doctor?" prosecutor Tanya Treadway asked.
"The patient is," Parran said.
Parran is a nationally known addiction expert who teaches doctors about the dangers of prescribing drugs.
The defense is expected to point out that Parran was the target of a federal investigation for billing fraud last year. The Cleveland Plain Dealer reported that the investigation ended with no criminal charges being filed.
Parran, meanwhile, has testified as a government expert in other federal cases involving medical practitioners, such as the Schneiders, charged with illegally prescribing pain killers.
The records from the Schneider clinic, Parran said, showed what he called "a dishonest practice."
Rarely were patients sent to specialists, physical therapists or other medical professionals to see treatments for their conditions, Parran said. Mostly, they received prescriptions for strong narcotics, which were short-acting and known to be habit forming.
Urine drug screens were often ordered but rarely done at the Schneider clinic, Parran testified.
When screenings were taken, the tests would show patients taking alcohol or street drugs with their prescriptions. Or, Parran testified, tests showed patients not taking medicines for which they were receiving frequent refills.
"But someone was," Parran said.
In each of those instances, the patients would leave the Schneider clinic with the same prescriptions they had received before.
"It was astonishing," Parran testified.
The Schneiders are charged with violating the Controlled Substances Act, health care fraud and money laundering. Prosecutors say they contributed to the deaths of 68 patients from 2002 through 2008.
The trial is in its third week. It is expected to last up to two months.