PROTECTION FOR CHRONIC PAIN OPIOID ABUSERS AND THEIR SUPPLIERS
Supreme Court protection for dangerous misprescribing of opioids for the non-medical condition of common chronic pain is empowering malpractice and opioid abuse, fueling lethal crisis
by Clark Miller
Published March 5, 2023
Feb 3 (Reuters) – A federal appeals court on Friday overturned the conviction of a doctor accused of unlawfully prescribing addictive opioids in Arizona and Wyoming after the U.S. Supreme Court issued a ruling in his favor that made it harder to prosecute such cases.
The Denver-based 10th U.S. Circuit Court of Appeals ruled that under last year’s Supreme Court’s decision, jurors were wrongly instructed on how to determine whether Shakeel Kahn knowingly prescribed powerful drugs in an illegal manner.
He was at the center of a Supreme Court ruling in January 2022 that raised the bar for what prosecutors must prove to secure convictions of doctors accused of fueling the U.S. opioid crisis by turning their medical practices into “pill mills.
Kahn, 56, has been serving a 25-year prison sentence after a jury in Wyoming in 2019 found him guilty of unlawfully distributing prescription medications, operating a continuing criminal enterprise and other charges.
Prosecutors said Kahn from 2011 to 2016 prescribed powerful pain drugs to people in Arizona and Wyoming in exchange for money after performing perfunctory or no examinations. They included one woman who died of an oxycodone overdose.
At trial, Kahn did not contest that patients abused their medications but disputed what his intent was in prescribing them drugs, asserting he had a “good faith” reason to believe his prescriptions were valid.
He took his case to the Supreme Court, which held that prosecutors have to prove that doctors knew they illegally prescribed drugs in violation of the federal Controlled Substances Act.
Still, the outcome illustrates what the Court intentionally or unintentionally has wrought: provision of a free pass – lacking material evidence of admission of knowledge and intent to prescribe the opioids understanding the potential for likely harm – to any prescriber willing to, under oath, simply utter words to the effect that they prescribed believing to the best of their training and professional competence that they were acting in the best interests of their patients struggling with intractable pain.
That is, a blanket free pass for essentially every instance of a licensed medical prescriber dispensing opioids to Americans.
That empowerment and protection from control, deterrence, or accountability for the generators now perpetuating America’s increasingly lethal iatrogenic opioid crisis is a lethal problem predicting continuously mounting illness and death, at the same time an afterthought, a fail-safe.
They were already protected, always have been.
Protected by America’s dependence on and demand for a continued supply of the very mood-altering substances driving lethal epidemics.
Do not treat that condition any more than does alcohol, both effective
as temporary anesthetics for chronic pain, in the same way: both affecting neurotransmitter activity in the brain resulting in numbing, “forgetting”, otherwise moderating emotion-laden awareness of pain. The research on alcohol as providing this effect is clear and established.
But alcohol is generally not recommended for daily, regular dosing to manage chronic pain, for sound reasons. That can lead to psychological dependence, with risk of overuse and well-known associated problems including problems with judgement; diminished mental acuity, “fogginess”; increased risk of a variety of physical problems including disease states; impaired functioning; and risk of accidental death.
Wait . . . that sounds familiar, or should. Long-term use of opioids, as prescribed, poses essentially the same risks. In a 10-year retrospective cohort study, long-term opioid use among patients with chronic non-cancer pain (CNCP) compared to patients with CNCP and not using opioids increased risk of all-cause mortality by a factor of 1.21, (hazard ratio: 1.21, 95% CI: 1.13, 1.31; P<0·001) with a database of more than 19 million patient records. Mortality risk was also higher specifically for cancer (HR 1.19, P = 0.041) and circulatory disease (HR 1.26, P<0.001).
The two temporary numbing agents are comparable, with similar and slightly different risk profiles: for opioids development of dependence, misuse, infectious disease, accidental overdose; for alcohol liver and other disease states, accidental physical injury.
Both provide a temporary cognitive and emotional deadening of the experience of pain, the pain reliably returning after the effects wear off, and often worsening over time. Because, of course, the source of that pain is not treated or addressed in any way. Instead, patients are diverted and disincentivized from engaging in the evidence-based treatments for the cause of chronic pain – psychotherapy and therapy support for changes in activity and movement – diverted by the effective, concerted efforts of medical and pharmaceutical industries instilling in them the lie that a medication can treat chronic pain. With lethal epidemic as outcome.
Opioid provision for chronic pain makes no more sense and is no more clinically and ethically responsible than recommendation for daily use of alcohol to numb chronic pain.
Dangerously and knowingly misprescribe.