BAKERSFIELD, Calif. — The police report is all David Cole Lang’s household has to explain his final moments on Earth.
Fifty pages of officer narratives and witness interviews crammed with grisly element, it lacks any rationalization for his demise. Ten months later, Lang’s widow, Monique, says she nonetheless has no clue as to why the 33-year-old fight veteran and father who struggled with opioid dependancy ended up fatally shot by a health care provider whom — so far as Monique knew — he hadn’t seen in over a 12 months.
“I didn’t understand why he was there,” she mentioned. “I still don’t.”
On that April night final 12 months, in line with interviews within the report, Lang yelled and stubborn on the dependancy and ache therapy physician, Edwin Zong, in his workplace, and leapt throughout a desk to punch him repeatedly. Hearing the physician scream for assist, the final affected person ready to see Zong that day ran to open the door. He instructed police he discovered Lang standing over Zong, curled in a fetal place on the ground, his face lined in blood and “the fear of a child in his eyes.”
“Hey!” the affected person yelled.
When Lang turned towards the doorway, Zong instructed police, the physician opened a desk drawer and grabbed a handgun. He fired three or 4 occasions. One bullet tore by means of the blood vessels in Lang’s neck. He staggered outdoors, collapsed in a car parking zone and died.
Local authorities concluded that Zong had acted in self-defense, and he confronted no prices. In an e-mail to Kaiser Health News, the physician declined a request for an interview however mentioned he believes he was focused for theft. “I was lucky I wasn’t killed,” he wrote. “Treating addiction is a very tough job, many doctors won’t do it.”
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The tragedy that performed out in Zong’s workplace speaks to a harmful pattern: In many elements of the United States, the variety of folks hooked on opioids far exceeds the capability of docs prepared and approved to deal with them. That is especially true in terms of professionals like Zong who dispense Suboxone or Subutex, each formulations of buprenorphine — broadly thought-about the optimum dependancy therapy as a result of all of it however erases opioid withdrawal signs with out creating a big excessive.
With tens of 1000’s of Americans dying yearly from opioid overdoses, the Food and Drug Administration lately signaled that it’s open to increasing the variety of medicine obtainable to ease withdrawal and scale back cravings, however entry to prescribers stays an issue even for the medicine that exist already.
One purpose for the scarcity of suppliers is that docs should take eight hours of coaching to prescribe the remedy and apply for a waiver from the federal Drug Enforcement Administration, as a result of the drugs is itself an opiate. Few docs are prepared to examine all these packing containers and tackle the generally troublesome sufferers who search the drug.
Patients hooked on heroin or prescription opioids like oxycodone or fentanyl undergo extreme withdrawal — sweats, tremors, nervousness — and are sometimes determined for medication-based therapy to wean them from the medicine or no less than quell their signs. For the cash-strapped sufferers, the cheaper the higher.
Doctors who settle for these sufferers, whether or not motivated by revenue or compassion, can develop into overwhelmed, seeing way over their places of work can deal with, opening the door to chaos and lawlessness. More problematic is that some clinics, like Zong’s, provide a mixture of providers — therapy for each opiate dependancy and ache. Patients being prescribed doubtlessly harmful narcotics are combined within the ready space with these struggling to kick dependancy.
Monique Lang appears to be like on the army memorabilia of her husband, who modified considerably after his three excursions of responsibility. He “was a lot different, especially around family functions,” his widow mentioned. “He wouldn’t want to go, and if he did, he was quiet and remote. I was like, ‘This isn’t you. What is going on?’ He never would say.” (Brian Rinker for Kaiser Health News)David Cole Lang served within the Marine Corps, with two excursions in Iraq and one in Afghanistan. After his return house, he suffered persistent ache, night time terrors and signs of post-traumatic misery dysfunction. In 2009, he acknowledged to his spouse that he was hooked on opioids however his household thought he had achieved sobriety by 2017, when he was killed. (Brian Rinker for Kaiser Health News)Karen Galyan, David Cole Lang’s mom, calls the Kern County Coroner to seek out out if there was any replace on son’s toxicology report. (Brian Rinker for Kaiser Health News)
Several years in the past in Vermont, which pioneered buprenorphine treatment, some small practices quickly swelled to 600 or 700 sufferers every, mentioned Dr. Richard Rawson, an skilled dependancy researcher on the University of Vermont. Doctors generally prescribed greater than their approved restrict, failed to check sufferers for drug abuse and — wittingly or not — fostered unlawful gross sales, Rawson mentioned.
“We know that when you have those types of practices where you bring large numbers of addicted individuals together it produces a mess,” he mentioned. “People are selling drugs in the parking lot and all kinds of wacky stuff like that.”
Inevitably, some sufferers relapse. Some develop into indignant in the event that they don’t get what they got here for. A solo practitioner like Zong — who by many accounts had few staff, an inclination to work late on his personal and a excessive money consumption — faces safety dangers.
Zong was involved sufficient to stow a gun in his desk drawer. “I keep a gun in my office for self-protection,” he mentioned in his e-mail.
Long Lines, Short Appointments
In California, demand for buprenorphine has solely grown with the opioid epidemic and up to date adjustments to Medi-Cal, the state’s Medicaid program, which have made it simpler and faster for low-income folks to get the drug. The program was expanded below the Affordable Care Act to cowl extra adults (three.eight million) and extra drug therapy.
In addition, starting in June 2015, docs had been not required to get prior approval from the Medicaid program every time they prescribed buprenorphine.
Within seven months, claims jumped 100 %, in line with the state.
Zong, an osteopathic doctor who had educated in inside drugs in New York, opened his Bakersfield observe in 2007. Situated subsequent to a marijuana dispensary, it was a one-stop store for ache administration, dependancy therapy and acupuncture. Though Zong’s medical coaching didn’t give attention to these areas, he had the required DEA waiver to prescribe buprenorphine by 2010, data present.
Zong had a repute for writing scripts, low cost and quick, in line with quite a few interviews with former sufferers, drug therapy professionals and pharmacy staff within the space. Lines of sometimes-agitated sufferers stretched from the ready room into the car parking zone, the road and the dust lot throughout the highway, sufferers and neighbors mentioned.
If the wait was prolonged, the appointments weren’t, the sufferers mentioned.
“When I walked in the first time,” mentioned Brian Adams, a former affected person, “[Zong] said, ‘What’s going on?’ I said, I’m a heroin addict. I need help. He said ‘OK, I’ll write you a prescription for Suboxone.’”
No consumption. No drug testing. No counseling. “I was in and out in five minutes,” Adams mentioned.
The value for the go to ranged from $80 to $100 money to safe the drugs, sufferers mentioned — far cheaper than anyplace close by.
Federal regulators say buprenorphine must be “part of a comprehensive treatment plan that features counseling and participation in social assist packages.”
Dr. Edwin Zong closed his observe after the deadly taking pictures, leaving a handwritten discover on the door. He stays licensed to observe in good standing however says he received’t return. Neighbors say sufferers nonetheless come by in search of him. (Brian Rinker for Kaiser Health News)
There was an possibility like that inside a number of miles of Zong’s workplace: Aegis Treatment Centers, which runs opioid therapy clinics intently regulated by the federal government. The clinics required providers together with consumption, urine testing and counseling for opioid therapy.
From a hard-up affected person’s perspective, Aegis had one other draw back: It had not but been authorised to simply accept Medi-Cal for buprenorphine, which was distributed on-site as take-home drugs. The vary of providers and medicine prices almost $700 for these with out insurance coverage, though a restricted variety of reductions can be found to the poor.
Zong’s Medi-Cal sufferers had it simpler: Their freshly issued scripts had been lined at native pharmacies.
Anger And Suspicion
Zong had good causes to be involved about safety. He’d had a handful of break-ins on the clinic, his car and residential — one lately, in line with the police report.
At some level, he turned licensed to hold and conceal a firearm. Adams mentioned he as soon as noticed him pull it out when Adams bought confrontational.
Angry that Zong wouldn’t prescribe him an anti-anxiety remedy, “I stood up and was like ‘Man, [expletive] you,’” Adams mentioned. Zong pulled out his gun and positioned it on the desk in entrance of him, Adams mentioned, and he shortly sat again down.
Patients and pharmacists mentioned Zong generally did add addictive anti-anxiety medicine like Xanax to buprenorphine prescriptions for folks presumably looking for to flee dependancy. Besides creating the potential for additional drug abuse, the mixture might be lethal, consultants say.
Records of Medi-Cal claims obtained by Kaiser Health News present that, along with treating sufferers with buprenorphine, Zong prescribed vital quantities of extremely addictive opioids, together with oxycodone and hydrocodone, in addition to habit-forming anti-anxiety medicines. They don’t present what combos of medicine had been provided every affected person.
Staffers at three pharmacies within the space mentioned they had been involved about peculiarities in Zong’s prescriptions or drug-seeking habits amongst his sufferers.
Myron Chang, a pharmacist on the Walgreens at H Street and Planz Road in Bakersfield, mentioned Zong’s prescriptions “were suspicious.” Staffers seen odd portions of drugs prescribed — 43, 46, he mentioned. Usually, docs name for 30 or 60 to match a every day dose for a 30-day month, Chang mentioned.
Chang added that Zong’s scripts generally included a doubtlessly harmful cocktail of sleeping drugs, narcotics and anti-anxiety medicines. He confirmed a reporter one among Zong’s 2013 prescriptions for Subutex and Xanax.
“We just stopped taking his scripts,” Chang mentioned.
In a 2013 inside memo at a Walgreens pharmacy in Bakersfield, Calif., a pharmacist calls the prescriptions of Dr. Edwin Zong “suspicious” and informs staffers the shop is not going to fill his prescriptions. (Brian Rinker for Kaiser Health News)
Not The Same Man
After the killing, police discovered a ski masks, a black hoodie and a lately used meth pipe in Lang’s automobile, in line with their report. Witnesses reported to police that Lang got here into the places of work saying “something about money” or that he was “waiting on his money.”
Court data present he had pleaded no contest for misdemeanor housebreaking in 2014 and served three days in jail.
Lang’s household is skeptical that Lang was attempting to rob Zong. They acknowledge, nevertheless, that he was not the person he was.
When Monique met Cole, as he was known as, she was nonetheless in highschool. He was an outgoing and humorous 19-year-old, with stunning inexperienced eyes and a pointy wit. In brief order, they married and he shipped out to Iraq. Then got here two extra excursions, in Iraq and Afghanistan. One explosion, then one other, almost killed him.
When he got here house to his spouse and child daughter, he “was a lot different, especially around family functions,” mentioned Monique Lang. He wouldn’t need to go, and if he did, he was quiet and distant. “I was like, ‘This isn’t you. What is going on?’ He never would say.”
In 2009, after Monique found cash lacking from the couple’s checking account, her husband got here clear: He was hooked on opioids. From then on, it was a curler coaster of drugs, heroin and rehab. In the center of all of it, they’d a son, now four.
Lang’s household mentioned the previous Marine was in fixed ache, bodily and mentally. He had a extreme again damage. He screamed in his sleep. His daughter, now 10, would sleep on the sofa downstairs, to flee the sound.
He secretly wrote suicide notes to his spouse and children.
Monique Lang wears her husband’s marriage ceremony ring round her neck. They met when she was nonetheless in highschool. She mentioned he was an outgoing and humorous 19-year-old, with stunning inexperienced eyes and a pointy wit. (Brian Rinker for Kaiser Health News)
Zong instructed reporters the day after the taking pictures that he didn’t bear in mind seeing Lang earlier than. But the household instructed police he was seen once in a while between 2012 and 2015, in line with their report, and that he acquired Suboxone for opioid dependancy.
In an interview, Monique Lang mentioned she as soon as accompanied Cole to an appointment. She didn’t just like the environment, she mentioned, and didn’t perceive how taking a drugs with no different providers would assist her husband.
But that was historical past — or so the household thought. By final April, they believed Lang was sober, getting the assist he wanted at Aegis.
Another Clinic ‘Overwhelmed’
Zong instructed police he carried out one last job on his clinic’s final day, with Cole Lang dying outdoors on the asphalt and squad automobiles en route: He wiped the blood from his battered face and agreed to write down his remaining affected person a prescription.
Although Zong — who additionally goes by the identify Yon Yarn — stays licensed to observe with an unblemished osteopathic board record, he says he is not going to reopen his observe.
His departure created chaos as determined folks depending on his prescriptions struggled to get assist elsewhere.
“We were overwhelmed,” mentioned Javier Moreno, regional clinic supervisor at Aegis. “We probably fielded a hundred, 200 calls from patients who were panicking — ‘I’m worried about relapse.’ ‘I don’t know what to do.’ ‘My prescription is expiring.’”
Even months after Cole Lang’s demise, neighbors mentioned sufferers nonetheless confirmed up at Zong’s door, with the scrawled “Closed” signal on it, hoping to seek out that the physician was in.
This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.
Related Topics California Healthline Mental Health Doctors Opioids Prescription Drugs Substance Abuse
