Doctors Examined in the Opioid Epidemic
Doctors roles in the opioid epidemic are under law enforcement and policymaker lenses as they balance oaths, prescription laws and risk of patient violence.
On the heels of the White House commission on opioid addiction recommending President Donald Trump declare a national emergency, Attorney General Jeff Sessions has announced that the U.S. Department of Justice Department (DOJ) will dispatch 12 federal prosecutors to U.S. cities ravaged by opioids. The prosecutors will rely on data in their efforts to uncover pill mills and track down doctors and other healthcare providers who illegally prescribe or distribute narcotic painkillers.
The prosecutors will be focused on investigating healthcare fraud and opioid scams, according to Police1.com.
Prescription Monitoring Program Data
A chair of the White House anti-opioid commission, New Jersey Governor Chris Christie, is opposed to legislation in his own state that would allow allow police and law enforcement officials to access the state's prescription monitoring program database without a court order.
Christie said the bill is unconstitutional, saying that he doesn't want prosecutors to "troll that stuff." Other opponents of the bill have also cited privacy concerns.
If you have a case and you have some probable cause, OK that's fine. Go to a court and get a judge to give you permission to look at that information," Christie said of prosecutors.
Focusing On Fentanyl
The White House commission interim report contained several recommendations, including:
- Increase the capacity for treatment, such as equipping all police officers with the overdose reversal drug naloxone
- Mandate education initiatives for doctors
- Establish and fund access to medically assisted treatment, such as in prisons
- Prioritize the Department of Homeland Security and law enforcement agencies to fight the trafficking and distribution of fentanyl
The commission's approach focuses on better training for doctors and their referral to medical treatment for opioid addiction, and focusing law enforcement on fentanyl -- not on prescription drugs. The report only mentions doctors twice.
In the second instance, it's in terms of helping them by connecting states prescription monitoring program data.
Focusing on Drug Fraud
One area Sessions is focused on is Medicaid fraud.
“Too many trusted medical professionals like doctors, nurses and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” said Attorney General Jeff Sessions in a prepared statement after recent healthcare fraud enforcement action that led to the arrest of 400 people, including 115 doctors, nurses and licensed medical professionals.
More than 120 people were charged with prescribing and distributing opioids and other narcotics.
The commission criticized proposed cuts in federal funding for drug and mental health programs under Medicaid, and the DOJ's escalating focus on treating drug addiction as a criminal justice issue.
Critics argue that by bringing the toughest charges possible, federal prosecutors will fill federal prisons.
Doctors Facing Violence
Patients have become angry or verbally abusive after doctors deny or stop an opioid prescription, according to the South Bend Tribune.
After Dr. Todd Graham, a practitioner in South Bend, Ind., was fatally shot because he did not give a patient an opioid prescription, three of the region's major medical providers asked local law enforcement for threat assessments to help them identify and reduce risks of violence.
In Indiana, a 2013 law requires patient to fill out an addiction questionnaire and other paperwork, sign a pain-management contract and take urine and other tests to get a prescription of 60 pills. This year, state lawmakers limited opioid prescriptions to seven days’ worth of medicine except in some cases of cancer, end-of-life care or exemptions set by the Indiana Medical Licensing Board.
Indiana doctors may only prescribe opioids after finding that other pain relievers are unsuitable, and they must file a written notice of the decision. If they don't follow the rules, they face the licensing board, may have their licenses revoked or they can be charged with a crime.
Dr. Kathryn Park, a pain specialist with South Bend Clinic said many doctors are reluctant to prescribe opioids. “A lot of doctors are fearful that they’re going to do something wrong,” she told the Tribune.
Dr. Natali Balog, a rheumatologist at South Bend Clinic and president of the St. Joseph County Medical Society, added:
We all live under a little fear as patients have felt the tightening of laws and regulations regarding opioids."
St. Joseph County Prosecutor Ken Cotter said Graham “did what we ask our doctors to do” by not over-prescribing opioids.
It can be a delicate balance. For example, how do doctors treat pain, often called the "fifth vital sign" in the medical world, in a patient that cannot be treated with non-narcotic pain relievers for other medical reasons?
“Even our normal patients who are very straightforward, they feel criminalized," said Balog.