Can Locking Up Pill-Pushing Doctors Put an End to Prescription Drug Abuse?
Last week, Dr. Lisa Tseng was found guilty of second-degree murder for writing prescriptions that led to patient overdoses. But it's not clear that punishing doctors will help addicts in need.
On Friday, after ten days of deliberation and a seven-week trial that garnered national attention, a jury found Dr. Lisa Tseng guilty of second-degree murder for writing prescriptions that led to the overdose deaths of three patients. Tseng, 45, was also found guilty of 20 other counts related to unlawfully prescribing controlled substances and using fraud to obtain a controlled substance.
It's an extremely rare conviction for a medical practitioner. But while the court decision will likely make doctors think twice before prescribing painkillers, some medical and legal experts argue that it does nothing to improve the root of the problem: physicians' education, and the pattern of drug addiction. At worst, says Northeastern University School of Law professor Leo Beletsky, such a conviction could even exacerbate rising levels of opioid overdoses by forcing doctor-shopping addicts to seek out illegal, more dangerous forms of the same high.
"The reality is that once you cut off someone's opiate supply, they don't just stop using just like that," says Beletsky. The research tells the same story: A study published in April by researchers at Boston Medical Center and Harvard Medical School showed that while a decreased supply of prescription opioids led to a reduction in related overdoses, it also intersected with a substantial spike in heroin overdose deaths.
"From a larger public health perspective, cutting off that patient and pushing them onto the street basically creates much more risk than it solves—and the DEA really doesn't seem to understand that," he says. If Tseng's conviction is intended to "scare doctors shitless," it also sends a risky message about how to treat addiction: "Their solution is you either fire the patient or you call the police."
Since 1999, the number of overdose deaths from prescription painkillers has quadrupled, killing more than 16,000 people in 2013—outpacing car accidents as the leading cause of injury death for people ages 25 to 64—according to the Centers for Disease Control and Prevention. As the federal government seeks to combat the prescription drug overdose epidemic it declared four years ago, the DEA has ramped up efforts to hold doctors accountable for egregiously prescribing painkillers to dependent patients.
As part of that push, the agency has prosecuted hundreds of doctors throughout the last decade, according to a list of investigations compiled on its website. Since 2003, just two physicians have been convicted of murder related to their prescribing practices, by the agency's own count. Both examples were extreme: Dr. Noel Chua, who was convicted of felony murder in 2007 related to the overdose death of the 19-year-old college student he'd been living with and dispensing drugs to; and Dr. Harriston Bass, who was charged with second-degree murder in 2008 for prescribing and selling controlled substances to minors, often at their homes and in hotels and casinos in Las Vegas.
Tseng, the osteopathic physician dubbed "Dr. Feelgood" by prosecutors, was arrested on a felony complaint in 2012 after a federal investigation found she had knowingly over-prescribed painkillers to patients without a serious medical need. The state medical board revoked her license shortly after her arrest. The district attorney's office estimated that her Rowland Heights, California clinic raked in $5 million during the roughly three-year-period when nine of her patients died. Tseng could face life in prison when she's sentenced on December 14.
For the families of the young men who died after taking painkillers prescribed by Tseng, the guilty verdict is a form of justice. "It's everything we hoped it would be and with the nationwide media attention it is putting all those other dirty doctors out there on notice that they are not above the law," April Rovero, whose 21-year-old son Joey fatally overdosed nine days after paying Tseng a visit in 2009, said in an email on Sunday.
Still, the conviction might be missing the point, says Beletsky, who acknowledges that Tseng was extremely far from being a model physician. She ignored multiple pleas from family members who begged her to stop prescribing opioids to their loved ones, according to Deputy District Attorney John Niederman.
"There's a lot of pressure on the DEA to do something, and on a state level, too, people are just dying and this has become a political issue," Beletsky says. "Using these criminal justice tools makes it sound like you're doing something, but you're actually working [against] the overall public health goal, which is to reduce drug misuse and reduce opioid overdose deaths."
The Obama administration recently announced aggressive new initiatives to crack down on prescription drug abuse, but the crisis has been years in the making—and largely fueled by the lawmakers and medical practitioners who are now seeking to curb it, says Dr. Gary Franklin, a neurologist and research professor of health services at University of Washington's School of Public Health. He dates the current epidemic back to the late 1990s, when he said many states passed laws lobbied by various pain management groups and drug companies "that basically gave doctors free rein to prescribe opioids and in fact encouraged it."
At the time, doctors were commonly prescribing long-term opioid use to treat chronic pain in cancer patients, thanks in part to savvy marketing from pharmaceutical companies. The medical philosophy soon evolved to: "Why wouldn't you want to comfort people in chronic pain in other experiences?" and not just cancer patients, as Franklin puts it. Thus began what he calls "the worst man-made epidemic in modern medical history."
Even Russell Portenoy, a neurologist who lectured extensively in the 1990s about the benefits of opioids and told a generation of doctors that drugs like OxyContin carried minimal risk of addiction for patients with chronic pain, now admits that much of his teachings were based on faulty research.
"Clearly, if I had an inkling of what I know now then, I wouldn't have spoken the way that I spoke," Portenoy, a professor at Yeshiva University's Albert Einstein College of Medicine, said in a video released in 2011 by the advocacy group Physicians for Responsible Opioid Prescribing. In the interview, Portenoy acknowledges that some of his own medical coaching may have encouraged a widespread medical culture of over-prescribing and helped spark the current opioid overdose epidemic.
"You look at that video and you go, How could that happen? How could that happen in American medicine?" says Franklin. "That's why I'm comfortable saying that American medicine and drug companies caused this. The question is, who has the authority to stop it?"
The solution, he said, has less to do with prosecuting doctors and more to do with training them on the dependency and overdose risks involved with prescribing high doses of painkillers. Franklin points to reforms made in his own state of Washington, where he chairs the agency medical directors' group, a collective of health care agencies that worked to repeal the state's excessively-liberal opioid laws in 2010.
Until medical boards and state agencies collaborate to draft new rules regarding opioid prescribing and utilize prescription drug monitoring programs to identify doctors with high-dose patients, Franklin says, convicting doctors of murder for writing prescriptions seems "a little bit backwards."
"If you don't take a more comprehensive approach to prevent this from happening," he warns, "then you're not going to prevent the next 100,000 people from becoming dependent and losing their lives."
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