The Centers for Disease Control and Prevention offers but one voice among many that has declared that the United States is in the midst of a prescription drug abuse epidemic. As the CDC notes: “Since 1999, the amount of prescription painkillers prescribed and sold in the U.S. has nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Overprescribing leads to more abuse and more overdose deaths.” Indeed, the agency says 44 Americans die daily due to prescription painkiller overdoses.
Those grim statistics provide a stark context for a startling Los Angeles case: Prosecutors have won a second-degree murder conviction against a female physician from the suburb of Rowland Heights for her role in the overdose deaths of three of her patients. The Los Angeles Times said this was one of a handful of instances in which a physician has been prosecuted on homicide charges for prescribing painkillers that led to a patient’s death.
The paper quoted experts who raised concerns as to whether the case would send a chill through the medical community, with doctors growing more sparing of powerful painkillers for patients who need them; others said that the physician involved had been reckless in her prescribing, had seen a patient overdose in her office but continued to write scripts for him, and had received multiple calls from authorities warning her that her patients had died with drugs she had prescribed in their systems.
Her attorney noted that California medical authorities had considered her wrong-doing and found her “in violation of standards” and argued that the physician should have faced civil malpractice proceedings, instead.
Perhaps. But pill addicts don’t make for the best plaintiffs and they certainly would be tarred by defense counsel as junkies deserving of little consideration. And families also typically prefer to have their loved ones alive and not have to be chasing damages after their deaths. It’s also unclear whether, after malpractice insurance payments get made, even a hefty civil win against a pill-dispensing doctor would send the requisite, widespread message to practitioners about the severity of the prescription drug abuse issue.
While the medical community has acted to address the prescribing bane — including improving pain-management regimens, supporting state laws against abuse of powerful medications, and putting in place monitoring systems so addicts can’t go, say, from emergency room to emergency room gulling harried care-givers into dispensing excess dosages — it, tragically, may take public awareness and the dual hammer of civil and criminal actions to effect change.
A recent issue of our Better Health Care newsletter focused on pain management. We interviewed Dr. Richard Ruskin, a pain management specialist who lost a relative to incompetent pill-dispensing that led to a fatal overdose. This is an area of medicine that requires careful listening to patients, a lot of thoughtfulness, and some clear-eyed realization that people who develop chemical addictions to pain-killers are not always going to be up-front about it. That doesn’t make them bad people, and it doesn’t mean we should write them off as junkies.