The Tennessee Department of Health is attempting to revoke the nursing license of Christina Collins, a nurse practitioner who was once one of the top opioid prescribers in the state.
State officials have said Collins’ prescriptions were so "colossal" that their only reasonable purpose was suicide or drug trafficking. She wrote these prescriptions in 2011 and 2012 while working for Bearden Health Associates, a pain clinic in the Knoxville suburbs.
On Thursday, The Tennessean published a 2,000-word investigation into Collins case, based on a review of more than 4,000 pages of public documents.
But, just in case if you don’t have time read all that, here are three of the craziest prescriptions described in the story:
Fifty-one pills a day
In 2011, Collins prescribed a female patient, identified only as E.R., 51-pills a day: 32 methadone, eight Roxicodone, four Soma, six Xanax and one Ambien. Methadone and Roxicodone are opioids, and this dosage amounted to more than 31 times what is currently recommended by the Centers of Disease Control and Prevention. Soma is a powerful muscle relaxer that can be dangerous when combined with opioids.
And that patient, identified only as E.R., was never actually seen by Collins. The nurse has admitted under oath that she issued the prescription without examining the patient personally.
Three fentanyl patches at once
Later that same year, Collins wrote a prescription for another patient, identified only as S.B., that included daily dosages of Opana, Roxicodone, Soma, Xanax, Restoril, Gralise and Mobic. The patient was also instructed to wear three fentanyl patches at the same time.
Fentanyl is an extremely potent opioid, often seen as one of the deadliest when abused. Opana is another opioid that is approximately three times as strong as morphine.
This patient later tested negative for many of these drugs, which suggests she wasn’t taking the pills any may have been selling them on the black market. Collins kept prescribing the pills anyway.
Morphine, an overdose, then more morphine
In 2012, Collins gave a massive morphine prescription to a patient who recently been hospitalized in an overdose. That patient had was a longtime customer of the Bearden clinic, and had been prescribed painkillers despite a troubling history of drug abuse.
The patient, identified only as P.C., came to the clinic for the first time in 2010. Clinic staff knew he had been previously arrested for drug trafficking and had a warrant for his arrest. He also tested positive for cocaine on one of his first visits. The clinic still gave him a prescription for morphine.
In 2011, P.C. was hospitalized in Knoxville after a mix of morphine and other drugs slowed his breathing to dangerous levels. Hospital staff, who were shocked by the patient's prescriptions lowered his morphine dosage as he was released from the hospital.
However, during P.C.'s next visit to Bearden, Collins tripled his dosage. Despite his recent overdose, she prescribed him more than 2,000 milligrams of morphine a day – 16 times what is currently recommended by the Centers of Disease Control and Prevention. One year after that, Collins added a quadruple dose of Actiq, a fentanyl lozenge, to his prescription.
Collins kept her nursing license
Earlier this year, the Board of Nursing put Collin’s nursing license on probation for two years, but board members rebuffed a recommendation from state attorneys that the license be completely revoked.
Collins argued to the board that many of her large prescriptions were simply refills of prescriptions that had been previously prescribed by doctors at the Bearden clinic. She said she later learned that the prescriptions were too large.
“If I were looking at doses like that in today’s time after the guidelines and everything that I’ve learned, yeah, I would think that was very high amounts,” Collins told the board, according to a hearing transcript.
If you’d like to know more, check out the full Tennessean investigation into the court case over Collin’s nursing license.
Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at firstname.lastname@example.org. Follow him on Twitter at @brettkelman.