Health Alert
GUIDANCE AFTER KENT COUNTY PSYCHIATRIST’S LICENSE SUSPENDED

The Delaware Division of Public Health (DPH) is issuing this health advisory to advise health care providers that Gregory Villabona’s medical license was suspended by Secretary of State Jeffrey Bullock and the Delaware Board of Medical Licensure and Discipline due to allegations of unprofessional conduct related to the prescribing and distribution of controlled substances. Secretary Bullock also signed a separate order suspending Dr. Villabona’s Delaware controlled substance registration. There may be former patients of Dr. Villabona who wish to obtain benzodiazepines, stimulants, and in a very few cases opioids, for continuing management of their symptoms. These individuals who may be misusing and abusing these prescription medications are at a higher risk of drug seeking behavior, illicit use of prescription medications and illegal substances and for dangerous withdrawal symptoms, including the potential for overdose or death.

Summary

Certain individuals with regular access to controlled substances — particularly if they are not well monitored by a medical practice — may be at significantly higher risk for medication misuse, physiological dependence, addiction or overdose. Medical providers prescribing controlled substances should monitor patients closely, screen for addiction risk, consider non-opioid medications for treatment of chronic pain and non-benzodiazepine medications and therapies for the treatment of anxiety disorders.

Background

Dr. Villabona is a psychiatrist with a practice in Dover who was previously disciplined by state licensing authorities in 2003 for unprofessional conduct arising from sex offenses in Maryland to which Dr. Villabona plead guilty. He was disciplined again in 2007 for violating the terms of a 2005 order, which, in part, prohibited Dr. Villabona from treating minor patients in unsupervised settings. In 2008, Dr. Villabona entered into a consent agreement with the state that placed certain permanent restrictions on his medical license, including limiting his practice to male patients over the age of 18.

Recommendations/Reporting

To help Dr. Villabona’s patients find appropriate continued psychiatric care and appropriate medication support, DPH is recommending that:

• Prescribers should evaluate which patients are at risk for benzodiazepine withdrawal. Benzodiazepine withdrawal can be serious and potentially life-threatening. Benzodiazepines include Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam) and Valium (diazepam). While most patients will not experience withdrawal symptoms, those who do will need to seek immediate medical attention. Signs and symptoms of benzodiazepine withdrawal may include:
  •  Sweating
  •  Tremor
  •  Increased heart rate
  •  Increased blood pressure
  •  Nausea and vomiting
  •  Hallucinations
  •  Seizures
• Patients can be safely prescribed benzodiazepines in an outpatient setting with a plan to continue the current dose or safely taper down to an appropriate dose or off completely. However, patients experiencing any of the above symptoms should be directed to the nearest emergency room for evaluation and treatment.
• Stimulant medications are prescribed for the treatment of ADHD and include medications such as Ritalin (methylphenidate), Adderall (amphetamine sulfate), Concerta and Vyvanse. While stopping these medication abruptly may lead to a return of ADHD symptoms and possible fatigue, irritability and depression, there are no immediate life threatening complications associated with their discontinuation.
• Prescribers should evaluate patients for substance use disorder risk as part of any regular clinical visit but especially if they will be prescribing any controlled substances in general and opioids in particular. A sample opioid risk assessment tool can be found at Help Is Here http://www.helpisherede.com/Content/Documents/Opioid-Therapy.pdf or https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf.
• If a patient appears to be at risk for substance abuse disorder, consider alternatives to controlled substances and in the event the use of these medications is unavoidable, monitor their use very closely. To the extent possible, use alternative therapies such as:
  •  Rehabilitative services, physical therapy, exercise and strength training for chronic pain
  •  Cognitive behavior therapy and relaxation techniques for chronic pain and anxiety
  •  Clinically appropriate non-controlled medications including but not limited to:
    •  acetaminophen and/or non-steroidal anti-inflammatory drugs (NSAIDs) for chronic pain
    •  selective serotonin and serotonin and norepinephrine reuptake inhibitors (SSRI and SNRIs) or tricyclic antidepressants (TCAs) for anxiety and chronic pain
    •  atomoxetine (Strattera) and/or guanfacine (Intuniv) for ADHD
• If you have questions about appropriate dosages, or tapering down dosages of prescribed medications contact the Division of Substance Abuse and Mental Health (DSAMH) Director of Addiction Services Dr. Sherry Nykiel at 302-255-9430 (office) 617-947-7434 (cell) or via email at sherry.nykiel@delaware.state.us.
• Patients can also be directed to contact DSAMH’s Mobile Crisis Line for Kent and Sussex Counties at 800-345-6785.
• For further information on substance abuse disorder for community members and medical providers, visit “Help is Here” at:  www.helpisherede.com. For a list of current locations that offer outpatient, inpatient, detoxification, recovery support, and recovery living, visit www.helpisherede.com/Resource-Guide/Here-for-me.
• To reduce “doctor-shopping” and to check the patient’s history for controlled substances, query the Prescription Drug Monitoring program at http://dpr.delaware.gov/boards/controlledsubstances/pmp/default.shtml.
• Patients should be reminded to avoid taking opioids with alcohol and sedatives or tranquilizers, including benzodiazepines (i.e. Xanax and Valium); muscle relaxants (i.e. Soma or Flexeril); sleeping pills or hypnotics (i.e. Ambien or Lunesta); and other prescription opioid pain relievers unless prescribed by a health care provider.
• Medical providers and law enforcement should be especially vigilant about potential patient overdoses or those with drug-seeking behavior, particularly in and around Dover where Dr. Villabona’s practice was located.
• For those serving pregnant or reproductive-age women, consider also screening for alcohol abuse by using screening tools such as the T-ACE questionnaire, which can be found on www.helpisherede.com and via Google.
• Patients should be reminded to lock all medications up or put them out of the way of anyone, including children or pets, who might try to consume them, whether by accident or on purpose. Patients can safely dispose of any unused medications at Delaware prescription medication drop boxes. There are 21 permanent drop boxes at this time. For a complete list of locations, visit www.helpisherede.com.

Additional Information

•   U.S. Surgeon General resources on opioids for physicians and patients:
  http://turnthetiderx.org/#
•   CDC Guidelines for Prescribing Opioids:
  https://www.cdc.gov/drugoverdose/prescribing/guideline.html
•   Department of State Press release on license suspension:
  https://news.delaware.gov/2018/03/19/secretary-state-announces-medical-license-controlled-substance-registration-suspensions/
•   Opioid risk assessment tool:
  https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf
•  Help Is Here
  www.helpisherede.com

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