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RICHMOND, Va. (AP) — By the time drug enforcement agents swooped into his small medical office in Martinsville, Virginia, in 2017, Dr. Joel Smithers had prescribed about a half a million doses of highly addictive opioids in two years.Patients from five states drove hundreds of miles to see him, spending up to 16 hours on the road to get prescriptions for oxycodone and other powerful painkillers."He's done great damage and contributed ... to the overall problem in the heartland of the opioid crisis," said Christopher Dziedzic, a supervisory special agent for the Drug Enforcement Administration who oversaw the investigation into Smithers.In the past two decades, opioids have killed about 400,000 Americans, ripped families apart and left communities — many in Appalachia — grappling with ballooning costs of social services like law enforcement, foster care and drug rehab.Smithers, a 36-year-old married father of five, is facing the possibility of life in prison after being convicted in May of more than 800 counts of illegally prescribing drugs, including the oxycodone and oxymorphone that caused the death of a West Virginia woman. When he is sentenced Wednesday, the best Smithers can hope for is a mandatory minimum of 20 years.Authorities say that, instead of running a legitimate medical practice, Smithers headed an interstate drug distribution ring that contributed to the opioid abuse epidemic in West Virginia, Kentucky, Ohio, Tennessee and Virginia.In court filings and at trial, they described an office that lacked basic medical supplies, a receptionist who lived out of a back room during the work week, and patients who slept outside and urinated in the parking lot.At trial, one woman who described herself as an addict compared Smithers' practice to pill mills she frequented in Florida."I went and got medication without — I mean, without any kind of physical exam or bringing medical records, anything like that," the woman testified.A receptionist testified that patients would wait up to 12 hours to see Smithers, who sometimes kept his office open past midnight. Smithers did not accept insurance and took in close to 0,000 in cash and credit card payments over two years."People only went there for one reason, and that was just to get pain medication that they (could) abuse themselves or sell it for profit," Dziedzic said.The opioid crisis has been decades in the making and has been fueled by a mix of prescription and street drugs.From 2000 to 2010, annual deaths linked to prescription opioids increased nearly fourfold. By the 2010s, with more crackdowns on pill mills and more restrictive guidelines on prescriptions, the number of prescriptions declined. Then people with addictions turned to even deadlier opioids. But the number of deaths tied to prescription opioids didn't begin to decline until last year, according to data from the U.S. Centers for Disease Control and Prevention.Martinsville, where Smithers set up shop, has been particularly hard hit.A city of about 14,000 near Virginia's southern border, Martinsville once was a thriving furniture and textile manufacturing center that billed itself as the "Sweatshirt Capital of the World." But when factories began closing in the 1990s, thousands of jobs were lost. Between 2006 and 2012, the city had the nation's third-highest number of opioid pills received per capita, according to an Associated Press analysis of federal data.Andrew Kolodny, a Brandeis University doctor who has long been critical of opioids, said that in recent years, doctors became less comfortable writing lots of opioid prescriptions and many big prescribers retired. That opened an opportunity for others."If you're one of the guys still doing this," he said, "you're going to have tons of patients knocking down your door."During his trial, Smithers testified that after he moved to Virginia, he found himself flooded with patients from other states who said many nearby pain clinics had been shut down. Smithers said he reluctantly began treating these patients, with the goal of weaning them off high doses of immediate-release drugs.He acknowledged during testimony that he sometimes wrote and mailed prescriptions for patients he had not examined but insisted that he had spoken to them over the phone.Once, he met a woman in the parking lot of a Starbucks, she handed him 0 and he gave her a prescription for fentanyl, an opioid pain reliever that is 50 to 100 times more potent than morphine.When area pharmacists started refusing to fill prescriptions written by Smithers, he directed patients to far-flung pharmacies, including two in West Virginia. Prosecutors say Smithers also used some patients to distribute drugs to other patients. Four people were indicted in Kentucky on conspiracy charges.At his trial, Smithers portrayed himself as a caring doctor who was deceived by some patients."I learned several lessons the hard way about trusting people that I should not have trusted," he said.Smithers' lawyer told the judge he had been diagnosed with depression and anxiety. Family members said through a spokesperson that they believe his decisions were influenced by personal stress, and emotional and mental strain.Even before he opened his Martinsville practice in August 2015, Smithers had raised suspicions. West Virginia authorities approached him in June 2015 about a complaint with his practice there, but when they returned the next day with a subpoena, they found his office cleaned out and a dumpster filled with shredded papers and untested urine samples.Some of Smithers' patients have remained fiercely loyal to him, insisting their severe chronic pain was eased by the powerful painkillers he prescribed.Lennie Hartshorn Jr., the father of the West Virginia woman who died two days after taking drugs Smithers prescribed, testified for the defense.Hartshorn said his daughter, Heather Hartshorn, told someone "she would rather be dead than in pain all the time." According to a form Heather Hartshorn filled out when she went to see Smithers, she had chronic pain in her lower back, legs, hips and neck from a severe car accident and a fall.When asked by Smithers' lawyer if he blames Smithers for anything, Lennie Hartshorn said he does not.Smithers has been denied bond while he awaits sentencing. His attorney did not respond to inquiries from AP. Smithers has said he plans to appeal.____Associated Press reporters Geoff Mulvihill and Riin Aljas contributed to this story. 6501

SACRAMENTO, Calif. (AP) — A staunchly conservative political party in deep-blue California will get to keep its name after the governor vetoed a bill aimed at banning what state lawmakers say are misleading monikers.Gov. Gavin Newsom announced Wednesday he had vetoed a bill that would have banned political parties from using "no party preference," ''decline to state" or "independent" in their official names.The bill would have applied to all political parties. But it was aimed at the American Independent Party, which has been an option for California voters since 1968.More California voters are registering with no party preference, now accounting for 28.3% of all registered voters. If "no party preference" were a political party, it would be the second largest in the state behind the Democrats.Critics say the American Independent Party has benefited from this trend because its name confuses voters into believing they are registering as independents. The party makes up 2.59% of California's registered voters, making it the third largest political party in the state after the Democratic Party at 43.1% and the Republican Party at 23.6%.In 2016, the Los Angeles Times surveyed the party's registered members and found most did not know they had registered to vote with the party. But Newsom said he vetoed the bill because he worried it was unconstitutional."By requiring one existing political party to change its current name, this bill could be interpreted as a violation of the rights of free speech and association guaranteed by the First and Fourteenth Amendments to the U.S. Constitution," Newsom wrote in his veto message.Representatives for the American Independent Party did not respond to an email and phone call seeking comment. The party's website says it nominated Donald Trump for president in 2016 and "God willing, 2020."Democratic Sen. Tom Umberg, the bill's author, warned the mistaken registration could have electoral consequences. People registered with another political party would not be allowed to vote in the state's pivotal Democratic presidential primary in March.But Newsom signed another bill by Umberg that could help people rectify any registration mistakes. The law, signed Tuesday, allows voters to register to vote or update their registration at all polling places on election day.If people show up to vote in the Democratic presidential primary and are ineligible because they are registered with the American Independent Party, they can change their registration on the spot and cast a ballot. The ballot would be conditional, meaning it would not be counted until after the person's registration could be verified. 2676

SACRAMENTO, Calif. (AP) — A baby blue bus rolls up to a Sacramento child care center, and out comes Lt. Gov. Gavin Newsom clad in a black cape, a Batman mask obscuring half his face and an Orange plastic jack-o'-lantern in one hand."The things we do for votes," says Newsom, a Democrat and the front-runner in Tuesday's election for California governor, before handing out Halloween candy to a shark, a Batman, a fire man, a princess and a variety of Disney characters.Rounding up votes is the singular focus for Newsom and his Republican rival, businessman John Cox as they make a final push to win over undecided voters and ensure their supporters cast a ballot.Both are rolling through the state in brightly colored buses, stopping for selfies and rallying their party's faithful in California's major media markets."It's nice seeing (politicians) acting like regular people, seeing the human side" said Denae Pruner, a 33-year-old state worker in Sacramento, said as Newsom handed out candy Wednesday. Her 1-year-old daughter dressed as an angel squirmed in her arms.With much of the nation gripped by the fight for control of the U.S. House, so too are the candidates for governor in a race that's often taken a backseat to the congressional races that will determine whether Democrats gain the power to investigate President Donald Trump and thwart his legislation.The Newsom and Cox campaigns are both steering their buses toward the state's most hotly contested congressional districts in Southern California and the Central Valley to campaign with the candidates there.Cox began his final push Thursday with an early morning interview with a conservative radio host in Sacramento. Without the money to match Newsom's avalanche of television ads, Cox is looking for free opportunities to reach his supporters.He expressed confidence, despite polls showing him with a double-digit deficit. As people get to know him, he said, they'll like what they see."People are ready for change," he told reporters outside the radio station before hopping on his lime-green bus for a trip to Vallejo, then Santa Barbara.For his closing argument, he's sticking with a message he's been hammering for months — California is too expensive, and it's the fault of politicians and interest groups invested in keeping it that way."The cost of living has just been so elevated by the political class that people can't afford it," Cox said told reporters.For Newsom, the final pitch is focused on educating children in the first three years of life and on his pledge to stand up to Trump. He's has largely ignored his rival, focusing his attacks on the president.When he was done handing out candy Wednesday, it was time to the talk to the press. Newsom removed his mask and changed from a Batman T-shirt to a pressed shirt and blue coat, the costume of a politician. He wasn't keen on the television image of him talking about the serious issues confronting California while dressed like a superhero."A bully calls you out, you gotta push back," he said of Trump. "We don't have to be navel gazing. We're not a small isolated state. This is California."Despite his pricey proposals, from universal health care to a big boost in spending for early-childhood education, he insisted he'll maintain the fiscal discipline for which outgoing Gov. Jerry Brown is known."I'm not profligate," he said repeatedly. "I'm committed to prioritizing."Cox scoffed at that idea, saying the state already has a bloated budget."The people of this state want change, they want an end to tax and spend," he said. "They want a chance to have a nice house and that's what I'm going to be talking about."Polling has showed Newsom with a comfortable lead — 49 percent to 38 percent in a Public Policy Institute of California survey last month, with a 3.6 point margin of error. He's also in much better shape to reach voters, with a whopping million in the bank on Oct. 20, compared with Cox's 0,000, according to their most recent campaign finance reports.Cox is targeting cable television, online streaming services and radio. He's also done a number of one-on-one interviews with local television stations.An independent group — whose donors include Los Angeles developer Geoff Palmer, venture capitalist Floyd Kvamme and his wife, Jean Kvamme — has bought digital ads with inflammatory messages. One criticizing a San Francisco needle exchange program ends, "Gavin Newsom for Governor? Are you on crack?" 4484

SACRAMENTO, Calif. (AP) — California Gov. Gavin Newsom has tested negative for the coronavirus. The governor's office said Newsom was tested on Wednesday after someone in the governor's office tested positive. The staff member who tested positive had not interacted with Newsom or anyone else who often sees the governor. The governor's office said Newsom took the test out of “an abundance of caution.” Newsom said Wednesday that he has been tested many times and has always been negative.California has reported more than 834,000 coronavirus cases and more than 16,300 deaths. 586

ROCHESTER, N.Y. — New York Attorney General Letitia James is promising to expedite the release of body camera footage in cases of alleged police misconduct that her office investigates. James spoke Sunday in Rochester, which has been in turmoil since the footage of Daniel Prude’s fatal encounter with police was released more than five months after his death. James said her office “will be proactively releasing footage to the public on our own.” It's unclear how many cases will be affected by the policy, since the attorney general’s office does not review all footage of police interactions with the public. 620