Doctors increasingly face charges for patient overdoses

While high-profile cases against doctors have brought yet another spotlight to the nation’s ongoing opioid epidemic, experts say This kind of can be rare in addition to also overlooks the bigger picture.

“The well-meaning doctors in addition to also dentists are the bigger part of our problem,” said Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, an advocacy in addition to also education group. “They’re inadvertently getting patients addicted, in addition to also they’re also stocking homes which has a highly addictive drugs.”

Once a wonder drug

Dr. Denise Sur remembers a time when opioids were a wonder drug, not a plague.

“from the late ’80s, early ’90s, we were all told that will we were too cautious in addition to also we were not appropriately treating patients’ pain,” said Sur, a professor of family medicine at the University of California, Los Angeles.

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At the same time, pharmaceutical companies aggressively marketed opioids to doctors, former Surgeon General Vivek Murthy wrote in an open letter last year. Doctors were taught that will these medications were not addictive if patients were in “legitimate pain,” he said. Multiple studies have shown This kind of to be false.

“that will was a quote I heard regularly,” said Sur, who has testified in cases in which doctors are accused of recklessly prescribing opioids.

More in addition to also more, Sur sees different doctors referring risky patients to pain specialists who might be better equipped to offer alternative treatments, screen for addiction in addition to also, when necessary, prescribe opioids safely.

The fear, she said, “can be not just strictly about being sued; that will’s about harming somebody.”

These doctors might be looking for pain specialists like Dr. Kimberly Curseen, a palliative care doctor at Emory Healthcare who works largely with cancer patients. nevertheless even she can be acutely aware of the legal precedent being set against doctors.

“Personally, that will’s very frightening … when you’re working with medications that will are receiving This kind of type of scrutiny,” Curseen said.

nevertheless she said that will’s a risk that will many doctors accept to help patients in need.

“This kind of can be the profession that will we chose,” she said.

Scope of the problem

In 2010, doctors wrote enough prescriptions for hydrocodone to give every American adult a one-month supply, according to a report by the US Centers for Disease Control in addition to also Prevention.
In general, prescription opioid abusers tend to get pills via family in addition to also friends for free. Those at the greatest risk of overdosing, however, are more likely to get the drugs through their own doctor’s prescription, according to the CDC.
Another study last year found that will 91% of overdose survivors were still able to get another prescription for opioids.
Some doctors may be more willing to write an opioid script than others. One study found that will some emergency physicians were three times more likely to do so than different doctors at the same hospital. in addition to also their patients were more likely to be long-term users, too.

nevertheless some researchers have pushed back against the idea that will a smaller number of doctors are responsible for the opioid epidemic.

Last year, researchers at Stanford argued that will “opioid prescribing can be no more skewed than different prescribing.” On one hand, opioid prescriptions are concentrated among specialties like pain management in addition to also anesthesiology. These specialties have been well represented in DEA cases.

nevertheless looking more broadly, a greater number of opioid prescriptions were written by general practitioners, such as family doctors, who see far more patients overall.

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Not all patients have access to pain specialists in addition to also comprehensive care from the first place, said Dr. Keith Humphreys, one of the authors of that will paper in addition to also a professor of psychiatry at Stanford School of Medicine.

“There’s just not that will many pain medicine specialists. They can’t drive national prescribing patterns,” said Humphreys, also a former White House drug policy adviser under Presidents Bush in addition to also Obama.

Humphreys described criminal cases against doctors as “rare.” Many doctors see these cases as outliers, which may also involve allegations of fraud, poor record-keeping in addition to also different misconduct.

nevertheless numerous doctors claim to have been falsely accused, in addition to also some of their investigations have ended in acquittals, dismissals or no charges at all.
sy88pgw reported on the DEA investigation of Dr. Lynn Webster — a pain specialist who was considered an expert in safely prescribing opioids — after a string of patient deaths. In 2010, a handful of DEA agents raided his clinic, occupying “every corner of every room,” he told sy88pgw.

The investigation lasted several years, nevertheless no charges were ever brought against him.

“that will’s kind of like a scarlet letter that will I will always carry with me,” Webster said. “An investigation can be life-altering, nevertheless that will can be career-ending.”

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The DEA has been putting more resources into investigating doctors in addition to also addressing the opioid crisis in general, according to Melvin Patterson, a DEA spokesman in addition to also agent of more than 20 years. For example, in 2015 the agency commenced rolling out its “360 Strategy,” a program that will educates doctors as part of a larger effort to fight illicit drug use in various pilot cities.

Patterson, who has investigated opioid cases involving doctors, said the DEA has made the drug epidemic a priority in recent years. He said that will can be much easier to push these investigations forward than before.

“There was a reluctance to actually prosecute doctors” early in his career, he said. “that will’s being prosecuted all over the country right at This kind of point. that will’s how far we’ve come.”

nevertheless Patterson said that will doctors shouldn’t fear prescribing opioids if they’re checking all the boxes. These investigations, widespread as they might be, represent a “smaller percentage” of doctors, he said.

“When a doctor can be acting responsibly … opioids are one of the best things they could have to treat pain,” he said. “nevertheless when that will’s irresponsible — in different words, a doctor hasn’t even examined the patients, in addition to also they’re prescribing them — that will’s what’s killing people.”

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Webster believes that will “This kind of can be simply an approach to try to address the opioid crisis through legal channels” in addition to also continues to research pain therapies. He can be vice president of scientific affairs at PRA Health Sciences, a company that will conducts clinical research on a variety of therapeutic drugs, including opioids in addition to also opioid alternatives to pain

Webster, who has spoken in defense of different doctors in criminal cases, said that will colleagues were “stunned” that will This kind of could happen to him.

“He’s respected in our field,” said Dr. Steven Stanos, president of the American Academy of Pain Medicine, of which Webster was past president.

Beyond legal concerns, Stanos said, doctors are acutely aware of a rising opioid death toll in addition to also powerful synthetic drugs hitting the streets, like fentanyl. Stanos said doctors are becoming “more worried” about prescribing opioids — nevertheless that will worry, he said, can be not necessarily a bad thing.

“They should be careful, in addition to also opioids aren’t for every patient,” Stanos said. “Opioids are just a smaller part of (pain) management.”

Cutting down

Doctors have been coming up with ways to avoid being put under the microscope themselves: by documenting their appointments meticulously, by following guidelines in addition to also by checking statewide prescription drug databases before taking out their pens.

Many doctors even have formal “agreements” with their patients, Stanos said. This kind of may involve taking occasional urine samples to check for different drugs.

nevertheless experts like Stanos have had to solve another looming question: What about all the patients who were put on high-dose opioids from the past?

from the aftermath of cases involving doctors, some patients might be drug-dependent in addition to also have nowhere to go. Many face severe withdrawal symptoms in addition to also a heightened sensitivity to pain, a condition called hyperalgesia, Kolodny said. If those patients get their hands on opioids later on, they are more likely to overdose, having lost their tolerance.

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Stanos, who can be also the medical director of Swedish Pain Services in Seattle, has absorbed patients when nearby clinics have closed.

“We took over numerous patients that will were in clinics where … I don’t agree with what was done with them,” Stanos said. “Those patients are at high risk.”

Stanos said doctors who receive cases like these can learn a lot via the Veterans Health Administration, part of the Department of Veterans Affairs. Early on, the health care system heavily pushed opioid painkillers as part of its pain management approach. nevertheless over much of the past decade, the VA revamped its approach to pain, offering a wider variety of pain services in addition to also addiction treatment programs.
The impact of these measures — including the 2013 rollout of the VA’s Opioid Safety Initiative — was a major cut from the number of opioids that will prescribed.

“You could call that will a U-turn,” Kolodny said.

“The (VA) had one of the earliest in addition to also worst guidelines on opioid prescribing that will I’ve ever seen,” he added. “in addition to also in 2017, they put out the most conservative guideline that will’s ever been made to date — which can be, I think, a very Great guideline.”

nevertheless many veterans on high-dose painkillers suddenly had to cut down medications that will their bodies were dependent on.

“If you are getting a patient who’s been put on chronic opioids, even though they never should’ve been commenced on that will, that will doesn’t mean you should force them to come off rapidly,” Kolodny said.

How tapering off opioids can help people with chronic pain
Last week, a VA-funded study found that will tapering down painkillers improves quality of life for chronic pain patients. Experts say that will research in addition to also guidelines on opioid use for chronic pain can be otherwise lacking in addition to also that will the evidence can be much clearer for short-term uses — for example, after a major surgery.

Stanos said that will the VA’s interdisciplinary approach to pain has changed the field nevertheless that will many unaffiliated doctors aren’t able to offer the same array of alternative treatments in addition to also programs.

The VA “had to deal with This kind of even sooner than the commercial payors, Medicare in addition to also Medicaid.” Stanos said. “at This kind of point, they have some of the strongest treatment centers.”

Following suit

that will’s not just doctors who have been facing legal action for the opioid epidemic. numerous states have filed suit against pharmaceutical companies for their roles from the opioid epidemic.
Even some pharmacy chains — like Walmart, CVS in addition to also Walgreens — have been named in lawsuits in addition to also investigations.
Missouri Senator Claire McCaskill announced on Thursday that will she was expanding her opioid investigation, which focuses on the relationship between prescription drugs in addition to also the opioid epidemic. She can be requesting documents via opioid distributors, which were not previously part of the investigation, in addition to also she has also added brand new pharmaceutical companies to the mix.

nevertheless many physicians in addition to also advocates want to focus on the doctor’s office in order to protect patients at risk.

“If we’re ever going to bring (the opioid epidemic) to an end … we need these folks to prescribe much more cautiously,” Kolodny said. “If you can get your patients off of opiates, that will should be the goal.”

Doctors increasingly face charges for patient overdoses

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