On Wednesday, dozens of medical nonprofit groups pleaded with hospital regulators to tighten national rules for prescribing painkillers. America has an opioid epidemic, and West Virginia is ground zero.
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Doctors there write 138 prescriptions for every 100 people. Now, the state has launched a crackdown. Seven doctors have lost their licenses and 15 more are being investigated. CBS News sat down with one of them.
Meet Dr. Michael Kostenko. He's written more than 40,000 prescriptions for oxycodone in the last two years.
He says at any given time, he has between 800 to 1,000 active patients in his practice. Nearly 100 percent of them get prescriptions for oxycodone.
Court documents show that Kostenko is one of West Virginia's top ten prescribers of painkillers.
CBS News correspondent Jim Axelrod asked him how many prescriptions he had written earlier in the year.
"Did you write 325 prescriptions the first week of January for more than 19,000 oxycodone pills?"
"Possibly," Kostenko replied. "It may well be."
Operating at the end of a narrow, unpaved, pot-hole filled, two-mile logging road, Dr. Kostenko hosts group sessions at his Coal Country Clinic. He posts videos of the sessions to YouTube, showing him explaining his approach to treating disease and pain through changes in diet and behavior.
After filling out a medical self-assessment, each patient pays $120 in cash. As the video shows, at the end of each class they're handed their prescriptions for pain medications. There are hardly ever private exams.
"There's very little that we need to do in private in our office," Kostenko explained to CBS News.
"You don't need to conduct a conversation, confidential about my use of pain medication, that wouldn't occur in private," Axelrod said. "Everyone is on the same pain medication," Kostenko told him.
In the last two years, three of Dr. Kostenko's patients have died after overdosing on a cocktail of pills -- including oxycodone -- prescribed by Kostenko along with pills prescribed by other physicians.
"Are you in contact with their primary care physicians to coordiante care?" Axelrod wondered. Kostenko told him no.
"Don't you have an obligation to talk to the other doctors? To make sure that cocktail isn't fatal," Axelrod asked. "If the conversation would be productive, absolutely," Kostenko replied.
"Well, the patient's dead," said Axelrod. "So how could the conversation be any less productive than what happened?"
"There should be better communication between all physicians dealing with these drugs. There just is not," Kostenko said.
The state has suspended Dr. Kostenko's license while they investigate the deaths, and decide whether to revoke his license. Robert Knittle, the Board of Medicine's executive director, says it's somewhat difficult to revoke or suspend a doctor's license in West Virginia.
"With prescription drugs, physicians can prescribe them. They're legal. It's not like cocaine or heroin."
Dr. Kostenko didn't seem to help his case when discussing one of the deaths with us. It was a woman being medicated by another physician -- a doctor Kostenko never consulted with.
"Do you bear any responsibility for that death?" Axelrod asked.
"Yes, I do," he said.
As he explains it, Kostenko wishes the hospital where his patient was being treated had reached out to him. He told us he didn't know how bad her condition was. New investigations have been opened into the overdose deaths of two other patients of Dr. Kostenko.
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