Former Casper Dr. Shakeel Kahn, accused of running a multi-state prescription drug conspiracy, wrote thousands of prescriptions that raised red flags on databases, a doctor of pharmacy said in federal court in Casper on Monday.

"His prescribing practices were inconsistent with best practices," said Dr. Gina Moore, who teaches pharmacy law and regulatory standards at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado.

"It appears he was prescribing at the highest possible doses and [sometimes] to multiple people in the same household," Moore said

She was the second prosecution witness called in the three week trial of Kahn and his brother Nabeel Khan [sometimes spelled Kahn], who are charged with distributing opioids and other medications outside the standard of care including causing a death, illegal use of telephones, money laundering, and having firearms during drug crimes among other crimes.

If convicted on all counts, Shakeel Kahn faces at least 45 years imprisonment.

If Nabeel Khan is convicted on his two counts, he faces at least 27 years imprisonment.

The prosecution called Moore because she works with prescription drug monitoring programs, which are electronic databases that track pharmacists, the prescriptions they fill, the doctors who wrote them, and patients

The databases, Moore said, help state boards of medicine and pharmacy, and law enforcement, to watch for a variety of red flags.

They include high dose prescriptions; prescriptions written over the course of months, indicating the doctor has not been monitoring patients; the same prescriptions written for multiple people at one residence; patients traveling long distances to obtain and fill prescriptions; people going to different pharmacists; people who "doctor shop" for the same medicine; and early refills.

The system is relatively new and not perfect, but it has been able to alert authorities to potential prescription drug abuse, she said.

Referring to a chart posted on the courtroom's monitors, Moore showed the data gleaned from thousands of prescriptions written by Kahn and filled for oxycodone, alprazolam  [Xanax], hydromorphone [Dilaudid] and carisoprodol [Soma].

Tuesday morning, Shakeel Kahn's attorney Beau Brindley hammered Moore's testimony.

Brindley didn't disagree with the statistics.

But he questioned who's really at fault for large prescriptions indicating potential abuse or diversion -- reselling pills.

Referring to each type of medicine, he asked Moore if a pharmacist -- who has a duty to monitor patients for abuse and not fill unsafe prescriptions -- if they filled those prescriptions.

Moore responded that the question was narrow, and "yes" -- "with qualifications."

She balked each time Brindley asked that question, and mentioned the qualifiers such as how far patients traveled or if they filled prescriptions at different pharmacies.

At one point, Brindley asked Judge Alan Johnson to tell Moore to answer his questions and not talk back.

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