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A Middle Tennessee doctor arrested last week for allegedly overprescribing opioids to addicted patients was also accused of prescribing a dangerous drug cocktail to at least two additional patients in the past.

The information came to light during a preliminary hearing for Dr. Gilbert Ghearing, a family practice doctor in Clay County, who was arrested last week on prescription drug charges.

More opioid prescriptions are dispensed per capita in the small county than anywhere else in Tennessee.

The federal government says Ghearing prescribed opioids and benzodiazepines repeatedly to two patients without a legitimate medical purpose, even after they overdosed.

Ghearing also previously prescribed risky drug combinations that comprise what’s known among some as the “holy trinity” to at least two additional patients in the past, according to Special Agent Jason Bell, with the U.S. Department of Health and Human Services Office of Inspector General.

The trio includes opioids, benzodiazepines and muscle relaxers that, when taken altogether, can cause death, Bell said.

Judge Alistair Newbern did not issue a ruling on whether there was probable cause to move forward with the charges after the five-hour hearing. Newbern said she will file a written order in the coming days.

Ghearing was released from federal custody on a $100,000 bond, surrendering his passport and DEA registration number as part of his conditions.

Ghearing has no criminal record and an exemplary record of past military service as a medic in the U.S. Army, his attorney Jay Steed argued.

“I think the government is going to be hard pressed to find an expert better qualified than Dr. Ghearing,” Steed said.

But those credentials don’t exonerate the doctor from wrongdoing, U.S. attorney Sarah Bogni said.

“(It) doesn’t mean the man is innocent. It means he knew better,” she said.

Larger Clay County investigation

Ghearing’s charges are just one branch of a larger investigation into a handful of medical providers in Clay County. He’s the second person criminally charged in the investigation, following John Polston, a pharmacist at Dale Hollow Pharmacy in Celina.

A “large number” of Ghearing’s patients filled their controlled substance prescriptions at two pharmacies that are already under federal investigation, according to court documents.

Federal agents are also investigating whether there was a potential kickback scheme between Ghearing and the pharmacy that operates out of the same building as his practice, Bell said.

One heavily redacted report discussed during the hearing Wednesday mentioned the owner of Anderson Hometown Pharmacy paid an unusually high rent to Ghearing, who owns the building.

Bell said agents were investigating whether the pharmacy owner paid a higher rent to Ghearing in exchange for him sending a high number of patients to her pharmacy.

The complaint

Ghearing was arrested at his practice in Celina last week by federal agents and transported to Nashville to appear in court. His arrest came two days after Ghearing, while under investigation for the offenses, bought a one-way ticket to the Marshall Islands.

During Wednesday’s hearing, Bell testified that Ghearing’s employees told the doctor they had received subpoenas from the government to appear before a grand jury the same day he bought the plane ticket.

According to the complaint, one patient’s mother had repeatedly called Ghearing’s practice and told him the patient was abusing the medications being prescribed by the physician, and ask him to stop.

The risky combination of opioids and benzodiazepines, which can cause suppressed breathing in patients, is well-documented by the U.S. Food and Drug Administration and CDC. Roughly one-third of overdoses involving opioids also involve benzodiazepines.

Ghearing is also accused of continuing to prescribe those two drugs to a second patient, despite having knowledge the patient was abusing them, had failed drug tests, stole drugs from other patients and had previously overdosed on prescription pills.

If convicted, Ghearing faces up to 20 years in prison and a $1 million fine.