Older pain drugs — including morphine, codeine and Dilaudid — found new life outside hospital wards, while new ones such as fentanyl and Opana were brought to market. OxyContin, a chemical cousin of heroin, had sales of more than $1 billion within a few years of its introduction.
Narcotic pain relievers now cause or contribute to nearly 3 out of 4 prescription drug overdoses and about 15,500 deaths each year, according to the CDC. For every death, 32 people are treated in emergency rooms for nonfatal overdoses.
Although the death toll has received considerable attention, the medical board and law enforcement agencies in California have not mined coroners' files, as The Times did, to identify doctors whose patients overdosed on drugs they prescribed.
Nor have officials tried to take advantage of detailed information that pharmacies provide to the state attorney general's office, listing the kinds and quantities of drugs prescribed, by which doctors and for which patients.
The Controlled Substances Utilization Review and Evaluation System was designed to help doctors learn whether any of their patients were seeking drugs from other physicians too.
The system could also be used to identify doctors who write large numbers of prescriptions for commonly abused drugs. The CDC has urged state authorities to use such programs to identify not only doctor-shopping patients but the physicians who cater to them. In California, authorities do neither.
Karl Finnila had a long record of drug arrests by the time he became Vu's patient. He was bipolar, had attempted suicide and had overdosed several times, according to coroner's records and his sister Sally, a tax accountant in Irvine.
Finnila, the oldest son of a Mattel Inc. executive, had been addicted to prescription drugs since he was a teenager, his sister said. He had been in and out of mental hospitals and was unable to hold a job.
He would lose touch with his family. But every so often, Sally would find him, take him to lunch and buy him a new pair of shoes and socks.
On June 29, 2007, Finnila was discharged from a hospital in Orange County, according to Carol Spetzman, a friend and caregiver. He had been treated there for a drug overdose, his sister said.
That same day, he filled prescriptions from Vu for hydrocodone and carisoprodol, a muscle relaxant, at a pharmacy down the hall from the doctor's office, coroner's records show.
Finnila then checked into a sober-living home in Westminster. After dinner, he went for a walk, sat down on a curb and died, coroner's records state.
The cause was "combined effects" of hydrocodone, carisoprodol and seven other medications prescribed by Vu and other doctors. He was 43.
Jennifer Thurber had been coping with pain for much of her life by the time she came under Vu's care.
Thurber's childhood was marred by a painful stomach condition that caused severe indigestion. She had corrective surgery when she was 11, but a car accident seven years later brought the problem back.
She was prescribed various medications for the pain and eventually began abusing them, according to her father, Charles, an Orange County sheriff's deputy.
Thurber obtained drugs through various doctors. On May 21, 2007, she filled prescriptions for morphine and methadone written by Vu.
Two days later, her father climbed the stairs of the family's Fountain Valley home and pushed open the door of her bedroom to ask her to get ready for dinner.
He found his daughter in bed, pale and motionless. Blood trailed from her nose. He laid her on the floor and attempted CPR.
Thurber died of an overdose of multiple drugs prescribed by Vu and two other doctors, coroner's records show.