The Tennessee Board of Medical Examiners revoked the license of a family physician with more than 25 years experience for prescribing medication to patients without proper justification. Sidi Yousseff Noor practiced at Holston Medical Group, an urgent care clinic with locations in and around Kingston, Tenn. The order claims Noor prescribed drugs including Actiq, Morphine and Ketamine to approximately 75 patients without proper justification while working at Crescent Medical Center in Morristown.

The Tennessee Department of Health disciplinary action report states that Noor’s license was revoked because he was found to have been engaged in professional misconduct, gross malpractice, failed to attempt to cure patients’ addictions to controlled substances, and failed to establish prior justification for issuing certain prescriptions to patients.

All three drugs for which Noor was cited for prescribing are potent anesthetics or painkillers. Actiq, in particular, is a form of fentanyl citrate, an opioid narcotic more powerful than morphine. Administered as a lollipop lozenge, Actiq was approved by the Food and Drug Administration (FDA) for very limited use in the treatment of breakthrough pain in cancer patients who had built up a tolerance to opioids. However, some doctors began prescribing Actiq to non-cancer patients for management of pain from migraines or headaches.

Capitalizing on the trend, Cephalon, the makers of Actiq, began promoting this off-label use, even telling doctors that the cancer drug could be used for backaches and injuries. A 2007 study by Prime Therapeutics showed that Cephalon’s marketing practices paid off. The study found that Actiq was used 90 percent of the time for these unapproved uses. But Actiq was never meant for patients who had not built up a tolerance to opioids, and serious problems soon followed. Actiq has since been linked to 127 deaths and 91 incidents of severe side effects. Both the FDA’s Office of Criminal Investigations and the U.S. Attorney General launched an investigation into Cephalon’s marketing practices.

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