The first installment of a two-part hearing on Dr. Scott W. Houghton's application for accelerated rehabilitation began Friday with a lesson on prescribing the controlled substance Suboxone to drug-addicted patients.

The hearing before Judge David P. Gold will resume March 27 in Middlesex Superior Court.

Houghton, 45, of Madison is charged with 47 felony crimes involving his drug-prescribing history while practicing in Old Saybrook and Westbrook. He has applied for accelerated rehabilitation, a diversionary program that allows first-time offenders to resolve their case with a dismissal.

Houghton, who has surrendered his license to practice medicine and had his prescription licenses revoked, arrived at the courthouse with his wife and sat at the defense table with attorney William F. Dow. The attorney is attempting to convince the judge that the case might look bad "at first blush," but that Houghton practiced medicine "in good faith."

Prosecutor Russell Zentner is opposing Houghton's bid for accelerated rehabilitation and said he would be calling witnesses after Dow presents his case.

Part of the state's case against Houghton involves his alleged mishandling of Suboxone prescriptions. The state alleges that Houghton broke the law by prescribing Suboxone and the anti-anxiety drug Xanax simultaneously, failing to test his Suboxone patients' urine and not referring them to counseling.

Middletown psychiatrist Stephen A. Wyatt, an expert on Suboxone, outlined the history of the drug, which was approved for use by doctors in 2000 as an alternative for opiate-addicted patients who otherwise would have to be treated at a methadone clinic.

Wyatt testified that prescribing Suboxone and Xanax simultaneously is not prohibited. He said failing to order urine tests is not illegal but is not "the standard of care" for drug-addicted patients. With regard to counseling, he said, by law, physicians only have to check off a box on a form to indicate they have the potential to refer a patient to therapy.

Wyatt also testified that it is not unusual for doctors to take cash payments, as Houghton did, for Suboxone. Some of Houghton's patients complained he was "in it for the money."

"There are a lot of Suboxone patients who don't go through their insurance," Wyatt testified. "There is such a stigma against this illness that they don't want it on their insurance, so they pay with cash or check."

In a memorandum in support of the accelerated rehabilitation application, Dow wrote that Houghton was well-meaning but naïve when it came to treating Suboxone patients, who represented just a small percentage of those in his care. He said Houghton wanted to be like an "old-time family physician." He made house calls and gave out his cellphone number with instructions to call any time, Dow wrote.

"When Scott began prescribing Suboxone, he, in effect, came to a gun fight with a water pistol," Dow wrote.

Dow said he submitted, under seal, a psychological evaluation of Houghton that explains how ill-equipped he was to work with drug addicts.

In the audience Friday were the sister and mother of Skye Van Epps, a patient of Houghton's who died from an overdose of Xanax and alcohol. They intend to speak when the state starts calling witnesses.

k.florin@theday.com