2022 Southern Medical Research Conference
North Carolina Physician To Pay $170K For Unlawful Opioid Prescription
Wilmington, N.C.-based family medicine physician Mark Armitage, MD, agreed to pay $170,000 to resolve allegations he prescribed opioids and other drugs outside the usual course of professional practice.
From 2009 to 2018, Dr. Armitage wrote nearly 9,000 prescriptions for Schedule II controlled substances, according to a June 23 news release from the U.S. Justice Department.
For example, he allegedly wrote prescriptions for a combination of an opioid, benzodiazepine and muscle relaxer, a trio frequently sought by drug abusers, on 400 occasions over a two-year period.
Additionally, according to the report, Dr. Armitage allegedly continued to prescribe a mother of four opioids and controlled substances even after she exhibited numerous signs of abuse and acute narcotic withdrawal.
Dr. Armitage, who had previously surrendered his Drug Enforcement Administration registration to prescribe controlled substances, also agreed to not reapply for authorization to prescribe Schedule II controlled substances until April 30, 2024.
Local Doctor Pays $170K To Settle Allegations Of Over-prescribing Opioids
WILMINGTON — A local doctor agreed to pay more than $100,000 to resolve alleged violations of the Controlled Substances Act.
Dr. Mark S.T. Armitage, a physician with Pelican Family Medicine in Wilmington, previously surrender his Drug Enforcement Administration registration to prescribe controlled substances. He has agreed not to reapply for authorization again until after April 30, 2024.
Armitage reached a civil settlement with the North Carolina Medical Board for $170,000. He acknowledged his multi-year prescribing of opioids and other controlled substances to one patient "constituted a departure from or a failure to conform to the standards of acceptable and prevailing medical practice."
The patient was a mother of four and Armitage continued to prescribe opioids to her after the patient exhibited numerous warning signs of abuse, experienced significant weight loss, and went into acute narcotic withdrawal. She was ultimately involuntarily admitted for addiction detox.
From 2008 to 2019, Armitage issued prescriptions for opioids and other controlled substances outside the usual course of professional practice and not for legitimate medical purposes. He allegedly wrote prescriptions for "the trinity," a combination of opioids, benzodiazepine, and a muscle relaxer frequently sought by drug abusers, on 400 separate occasions between 2016 and 2018.
In total, Armitage allegedly wrote 9,000 prescriptions for schedule-II controlled substances over the same two-year period.
"Doctors take an oath to, first, do no harm," U.S. Attorney Michael Easley Jr. Said in a press release. "Anything else is unacceptable, especially when it comes to prescribing opioids and other dangerous drugs. Irresponsible doctors endanger their patients' lives and can put a tremendous toll on society at large."
The resolution in Armitage's case coordinated among the DEA and the U.S. Attorney's Office for the Eastern District of North Carolina.
"This case is just one part of our continued commitment to combat the opioid crisis by holding doctors accountable for compliance with the Controlled Substances Act," Easley said in the release.
The U.S.'s legal assertions are allegations only and there has been no admission or judicial determination of liability.
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Jesse Helms, Family Values, And His Gay Granddaughter
This story originally published online at The Assembly.
In 1995, the year before he'd conduct his fifth and final campaign for the U.S. Senate, Jesse Helms received a personal letter from the widow of a friend and supporter.
The woman, Patsy Clarke of Raleigh, had lost her gay, 31-year-old son to AIDS the year before. After Helms said homosexuality was a "filthy, disgusting practice," Clarke decided to write to him.
She urged Helms "not to pass judgment on other human beings as 'deserving what they get.' No one deserves that. AIDS is not a disgrace, it is a TRAGEDY." She wished Helms had known her son. "I ask you to share his memory with me in compassion," she wrote.
Two weeks later, Helms wrote back to acknowledge her "poignant letter," but he didn't change course.
"As for Mark, I wish he had not played Russian roulette in his sexual activity," Helms wrote. "I have sympathy for him–and for you. But there is no escaping the reality of what happened."
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Clarke cried when she read it. Then she got mad. She joined forces with her friend Eloise Vaughn, another Raleigh woman who'd lost a gay son to AIDS, and created Mothers Against Jesse In Congress to oppose the senator's reelection bid.
The two earnest, grieving mothers in their 60s were compelling figures as they took on the four-term senator, one of the nation's most influential conservatives.
They were featured in The New York Times and People magazine, and spoke at an event affiliated with the Democratic National Convention in Chicago. They produced a TV ad scolding Helms for appealing "to the worst in all of us," which ended with Clarke shaking her head and saying, "Oh, Jesse," as Vaughn and three other moms frowned.
Helms, who died in 2008, said he didn't hate gay people. "I don't even know any homosexuals," he said as he was preparing for his last reelection campaign.
Actually, he did.
Among the staffers working to reelect him in 1996 was his granddaughter, Jennifer Knox. She'd just graduated from the former Baptist college her grandfather had attended, Wingate University, where she'd quietly come to terms with her sexual orientation.
'Not Your Garden-Variety Lesbian'In the opening sentence of his 2005 memoir, Helms, then 83 years old, wrote proudly, "I was born and reared in a small town." Monroe, 25 miles southeast of Charlotte, was then a mill community of 3,000.
Early in his career, Helms was a newspaper reporter and editor, a congressional staffer, and executive director of the NC Bankers Association, where he edited the group's publication and hosted a weekly TV show on WRAL. He served two terms on the Raleigh City Council.
In 1960, he joined WRAL full-time as an on-air editorialist, and became regionally famous for his combative, fiercely conservative commentary.
Helms had been a Democrat, but he switched his registration to Republican and was elected to the U.S. Senate in 1972. He was re-elected four times. While all of his campaigns were difficult, the 1984 run was particularly long and angry; he defeated Democratic Gov. Jim Hunt in what was then the most expensive Senate race ever.
In fundraising letters, ads, and statements, Helms tied Hunt to gay groups in New York and San Francisco to show that Hunt was too liberal for North Carolina. "Let's talk about the homosexuals, the labor-union bosses, and the crooks that support Gov. Hunt," Helms said.
But it wasn't until AIDS emerged as a major public health issue that criticizing gay people grew into a top priority for Helms. He became the leading congressional critic of gay rights and opposed a bill funding AIDS research (he said it was too much money compared to what the federal government spent fighting other diseases).
"In his campaign against homosexuals, which took on bitter and often even hateful language, Jesse embraced his final moral crusade," wrote William Link in his authoritative biography of Helms, Righteous Warrior.
Helms' supporters considered him a God-fearing man; his opponents thought he was sanctimonious.
Helms said "the homosexual rights crowd" had "twisted the AIDS issue into one of civil rights." Gay activists were using the issue to "promote and legitimize their lifestyle in American society." He said "the homosexual movement threatens the strength and survival of the American family as a basic unit of society."
He considered gay people "weak" and "morally sick." "There is not one single case of AIDS in this country that cannot be traced in origin to sodomy," he said, even though AIDS could also be transmitted through blood transfusions. He refused to talk with the mother of Ryan White, a teen who died of AIDS in 1990 after receiving HIV-positive blood.
Even by the standards of the era, Helms's comments were harsh. Some conservatives, such as Sen. Orrin Hatch of Utah, urged him to tone it down, but with no success.
In early 1993, President Bill Clinton nominated Roberta Achtenberg as assistant secretary in the Department of Housing and Urban Development, a job that required Senate confirmation.
Achtenberg, an elected city supervisor in San Francisco, was the first openly gay person nominated for high federal office. Helms led the campaign against her confirmation.
"She's not your garden-variety lesbian," Helms said. "She's a militant-activist-mean lesbian, working her whole career to advance the homosexual agenda. Now you think I'm going to sit still and let her be confirmed by the Senate? If you want to call me a bigot, go ahead."
Helms showed Republicans video of Achtenberg kissing her partner in a gay pride parade. "Call it gay-bashing if you want to," he said. "I call it standing up for America's traditional family values."
San Francisco politics can be bare-knuckled, but Achtenberg was startled by the ferocity of Helms' attacks. "The thing I most remember was how nasty and personal he tried to be—to try and personally wound the opponent," she told The Assembly.
"I'm actually quite a nice person," she said.
She recalled Helms' describing her partner and their then-7-year-old son as a "so-called" family. "Thirty years later, I can still get emotional about it," she said. "To impugn your family is a real insult."
Achtenberg said her opponents extended the debate partly so they could raise more money through direct mail critical of her. In that pre-Internet era, direct mail was a major source of cash for politicians, and Helms' organization excelled at it.
After three days of debate, Achtenberg was confirmed, 58-31. She went on to chair the California State University Board of Trustees and serve on the U.S. Commission on Civil Rights.
"I try not to think too much about Jesse Helms," said Achtenberg, now 72. "My own life is full and rich."
Granddad JesseJennifer Knox, now 49, was raised in a leafy old neighborhood outside downtown Raleigh and now lives nearby. Her mother, Jane, is one of Jesse and Dorothy Helms' two daughters; they also adopted a son. Jennifer grew up next door to her grandparents, and saw them daily when the Senate was not in session.
She was close to her grandfather. She has warm memories of him napping in his favorite chair with the television on and his dog, Patches, nearby. She remembers eating ice cream with him every night after dinner and the smell of his unfiltered Lucky Strikes.
"There really are, for me anyway, two Jesses—the granddad and the senator," she told The Assembly. "The granddad is the bigger influence on my life."
In the summers, she visited her grandparents in Washington. One of her most memorable moments came in 1994, when Helms arranged for her to shoot baskets at a playground with Sen. Bill Bradley, the New Jersey Democrat who'd been a star player for the New York Knicks in the 1960s and 1970s.
Jesse and Dot Helms drove to the playground in what Bradley remembered as a "ridiculously old car."
Knox was then a student at Wingate University, where she played guard on the basketball team. Bradley was 50 years old, but she marveled at his skills, even in middle age.
Bradley disliked Helms's raw political style, but he said his view of his foe shifted that day as he watched him beaming at his granddaughter. Bradley told Link, Helms's biographer, that he saw him for the first time as a person and grandfather, not a "the personification of evil."
Helms took Knox to the White House twice, once for a dinner with a large group that included Clinton. She and Sen. Helms were pulled into a side room for a few minutes, where Clinton turned on the charm as the three of them chatted.
After Wingate, Knox worked on her grandfather's campaign in 1996. She then earned a law degree from UNC-Chapel Hill in 2000 and became an assistant district attorney in Wake County. She ran for district court judge in 2004, and took her grandparents and parents with her when she filed to run, praising Helms' commitment to public service.
"Thank you, sugar," Helms said as reporters watched. "I appreciate it, and yes, I'm choking up a little."
Knox was a Republican, but the race was officially nonpartisan. She won on the same night George W. Bush was reelected. Helms wrote proudly in his book: "November 2, 2004, was a great day for America—and for our family!"
Knox served 10 years as a judge and was elected Wake County Clerk of Superior Court in 2014; she lost reelection four years later, and has been in private practice ever since.
Knox realized in college she was gay, but she wasn't open about it. For her, coming out was a gradual process.
She told her parents in 2002. "That did not go over well," she said. Her mother said she loved her, but told her she needed to go to therapy. She went, and said the session started like this:
"Why are you here?"
"I'm gay," Knox responded.
"So," the therapist asked again, "why are you here?"
That was their only meeting.
In 2004, a website with a history of naming closeted gay politicians outed Knox during her run for judge, saying she was living with her female partner. Knox didn't publicly address the rumors, and Wake County voters didn't seem to care.
'I Didn't Know How He'd React'Knox and her partner married in Canada in 2007, and held a housewarming party that Knox considers her coming out to friends and colleagues. "I was never shouting it from the rooftop," she said. (She and her wife divorced in 2019, and share custody of their two children, 13 and 10.)
She never told her grandfather, who was in poor health for several years before he died, that she was gay.
"I'm not the kind of person to confront him about his views," she said. "We really didn't talk about politics as a family. It was almost like it was two separate lives between his political life and his family life."
Helms' public life could be difficult for his family. They knew him as a kind, generous man, but when Helms was in the arena, he was more than willing to brawl. He was the most polarizing national politician of his era, an aggressive populist conservative decades before Donald Trump rode that style to the White House. He worked to "own the libs" before that became the rallying cry of the right.
When the left punched back, the Helms family pulled together around the senator. Knox recalled when gay activists climbed the roof of her grandparents' house in Arlington, Virginia in 1991, and inflated a giant fabric condom.
Still, his politics are not her politics. "He had strongly held beliefs that weren't always right," she said. She's no longer a Republican, and has registered as unaffiliated.
"I'm way more liberal than I used to be," she said. She believes in limited government, but said today's Republican Party "wants to creep into everyone's personal life" and won't acknowledge racism built into the system.
It irks her when conservatives refer to sexual orientation as a chosen lifestyle. "Of all the people in the world—Jesse Helms's granddaughter—you think I chose this?" she said. "There have been many times I've been judged because of who he is and not who I am."
We talked unhurriedly in a cozy conference room in her law office overlooking Raleigh's Crabtree Valley Mall. Larry, a small mixed-breed dog she adopted from a rescue group, rested quietly on the floor nearby (he's featured on her website, which says, "Larry stole her heart.").
She wore a T-shirt and jeans, her hair pulled back, and was friendly and relaxed, sometimes sitting with a foot tucked under her. I told her that I have an openly gay daughter who had recently married.
I read aloud some of her grandfather's comments about gay people. She was pensive. I asked for her reaction. "Ouch," she finally said with a chuckle. "I was thinking that was probably why I didn't tell him."
She added: "I didn't know how he'd react. We did have a pretty strong bond. I didn't want to risk losing that relationship."
She said she's blocked out aspects of his Senate career. The disconnect between the "very sweet" man she knew and his barbed public comments was confusing and painful, and kept her in the closet for years. She still hasn't read his memoir or any of the books about him. "I'm not ready," she said.
Several times she said she loved her grandfather and he loved her. I asked what she thought his reaction would have been if she had told him.
"Probably very conflicted," she said. "Obviously, it's not something he would have approved of. That's a question I'll never know the answer to."
Knox believes Helms used strident language in the public arena because it worked for him. It energized hardcore conservatives. She compared some of Helms' comments to statements Lt. Gov. Mark Robinson has made; the Republican gubernatorial candidate has also criticized gay people harshly.
"He says ridiculous things very forcefully," she said. "People are drawn to that."
Playing To His AdvantageCarter Wrenn, Helms's former strategist, was a key figure in the 1978, '84, and '90 campaigns before he split with Helms over matters personal and professional. He still advises Republican politicians, but any warm feelings he had for Helms are long gone.
"Jesse had a lot of demagogue in him," Wrenn told The Assembly as he smoked a cigar behind his desk in his spacious North Raleigh office. "When he saw something he could play to his advantage, he did it in a minute, whether it was race or gays or whatever. I'm sure he did not like gays. But the meanness of it came from the demagoguery."
Helms had long been strongly conservative on racial issues, even before his TV days. But in the '90s, race wasn't as effective an issue for Helms as it had been in his prior campaigns, Wrenn said. "He was grabbing the new thing" when he latched on to anti-gay issues.
"If it had backfired," Wrenn said, "he would have stopped."
He never did. In Tim Kirkman's 1998 documentary Dear Jesse, the filmmaker, a North Carolina native who is gay, said he thought he had nothing in common with Helms until he realized they both were obsessed with gay men.
Helms noted "with confidence" in his memoir that most Americans opposed gay marriage, which was true in 2005. He knew cultural politics better—and played it more effectively—than any politician of his era.
Helms said he didn't know any gay people, but that was naive, reflective of an earlier time when homosexuality wasn't acknowledged. As long as they kept quiet, gay people could be tolerated, even accepted, a view Helms endorsed. Helms likely knew plenty of gay people, whether or not he realized it.
Among them was his pollster, Arthur Finkelstein, although his orientation was not common knowledge until after he stopped working for Helms. Finklestein married his longtime partner in 2004 and died in 2017.
Finklestein, who considered himself a libertarian, split with Helms in 1990 because of Helms's emphasis on hot-button social issues. "I'm not in the Moral Majority," Wrenn recalled him saying, referencing a political organization founded by televangelist Jerry Falwell that pushed conservative social values.
Wrenn tried to talk him into staying, but Finklestein wouldn't budge.
In his last year in office, Helms did come around in one related area—he supported expanding federal aid to fight AIDS in Africa. He and the rock star Bono had started an unlikely friendship, and Bono opened Helms's eyes to the crisis abroad.
Helms had believed AIDS was confined to gay men and drug users, and was surprised to learn that babies in Africa were contracting the disease from their mothers. "I was wrong," Helms wrote in his memoir.
But that didn't mean he'd changed his views about gays and gay rights. He told a reporter he would "make myself sick if I did such a thing."
Whose Family Values?Patsy Clarke and Eloise Vaughn are in their 90s now. The founders of Mothers Against Jesse In Congress live 5 miles from each other in Raleigh. They don't see each other often, but stay in touch.
A few weeks ago, I drove Vaughn, who lives in a condo near Helms' old house, to see Clarke in her suburban retirement community. They had not seen each other in 10 months, and beamed in each other's presence. Clarke sat in a padded chair with her wheelchair and Vaughn nearby. At one point, they clutched hands as they recalled their shared battle.
"It all comes back, doesn't it, Eloise? I feel shaky inside," Clarke said. "What we were fighting for was human rights, not just beating Jesse."
There is much that unites them—losing a husband at an early age, losing their sons (both named Mark) even younger, and taking Helms to task.
As a political action committee, their group was not powerful in any conventional way. It existed for just one election cycle, and raised only $65,000. But it was effective in other ways.
Vaughn, a Democrat, had long been involved in politics. Her husband was speaker of the North Carolina House in 1969, and later served on the state Supreme Court. He died of cancer in 1986. She met Helms once at an event with her husband.
Clarke, then a Republican, had not been involved in politics, but her husband, Harry, was a friend and supporter of Helms. Harry Clarke died in a plane crash in 1987; Helms called Clarke to console her, and placed his praise for Harry in the Congressional Record.
Patsy was deeply conservative. The Clarkes had hosted John Birch Society meetings in their home, and she had always voted for Helms. But his comments about her son prompted an awakening.
"As the door to Mark's life was closing, a different door in my life opened, one that showed me an understanding I had not dreamed possible," she recalled in her book, co-written with Vaughn and journalist Nicole Brodeur.
Clarke and Vaughn weren't ashamed of their gay sons. They loved them. They were proud of them. And they wanted the world to know. In that era, that made them different. It made them heroes and surrogate mothers to all the gay people whose families had rejected or shunned them.
Clarke and Vaughn didn't care about what the president of the local women's club thought. Or the people at church. And they weren't going to let Jesse Helms or any other politician use their sons—and other people's dead gay sons—as a means to raise money and wield power.
They managed to get under Helms's skin—enough that his campaign included their group on its list of 14 "ultra-left, fringe special-interest groups out to smear Jesse Helms."
As gay Americans increasingly came out of the closet in the 1990s, they saw the mothers as a symbol of hope for how families could be. Straight Americans saw them as a couple of women with enough courage to love their sons publicly. They weren't the first parents to boldly support their gay children, but they emerged at a pivotal time and built momentum for others to follow.
"We didn't have horns," Clarke said. "The more we said we had gay children, the more people told us their stories."
Clarke and Vaughn had heard over the years that Helms had a gay granddaughter. They wished he'd known, although they are skeptical that it would have changed him.
In taking on gays, Helms said he was protecting family values. "It made me sick," Vaughn said.
She and Clarke defined those values differently. They thought Helms' stark, angry approach divided families just when they needed each other most, to the point that some families would not go to their own sons' funerals.
They took the political rallying cry of "family values" and turned it on its head, historian Robert Hunt Ferguson wrote in an article about their "grassroots maternalism."
Their view has largely prevailed. In 1996, 68 percent of respondents told Gallup they opposed gay marriage, and 27 percent said they supported it. Now, those numbers are flipped. The Republican Party still opposes gay marriage, but in an era when it's difficult to get a strong majority of Americans to agree on anything, gay marriage is now widely accepted.
Helms beat Mothers Against Jesse and their allies, but his victory against gay affirmation didn't last. Neither did his chokehold on Knox's expression of her true identity. Eventually, over the years and with a lot of anguish, she has revealed more and more of who she is.
When her grandfather was still alive, Knox turned down a request from a reporter to speak publicly about her orientation.
"I'm way more comfortable with myself and who I am than I was back then," she said. "I can't tell my children to be who they want to be, and live their lives to the fullest, if I'm not setting an example for them."
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