UPDATE: MEDICAL MISPRESCRIBERS SHIELDED AND EMPOWERED BY U.S. SUPREME COURT PARDON WHILE OPIOID DEATHS MOUNT
Strengthened media, regulatory, and legal shields for America’s over-prescribing and misprescribing medical professionals predict empowered, reckless, lethal dispensing of opioids as deaths mount
by Clark Miller
Published September 25, 2022
Over the past two months I’ve published posts that describe predictable and ultimately lethal information control, necessary distortions and longstanding cultural pathologies protecting centers and sources of power that are perpetuating America’s opioid crisis by shielding and enabling continuing misprescribing of opioids.
From an August 7 post –
The United States Supreme Court,
in a related and appropriately timed decision, let medical prescribers off the hook for running “pill mills” or otherwise helping to generate the opioid crisis by overprescribing or otherwise misprescribing the addictive Schedule II controlled substances.
A Supreme Court decision protective of American Medicine’s incompetent and criminally negligent generation of the opioid crisis significantly bolsters protections afforded by America’s medical-media collusion, empowering continuing overprescribing and misprespcribing of opioids driving the lethal epidemic.
Overprescription and misprescribing of opioids
has continued over the years and decades of an increasingly lethal epidemic, described here,
And while continuing to misprescribe, decades into an increasingly lethal opioid crisis, America’s medical professionals only began protecting patient rights and health after forced to at risk of legal violation for failure to meet longstanding, established ethical requirements for any medical intervention – failure to provide informed consent.
From a September 18 post –
The precious legalistic, naïve rationalizations from The Court were grounded in premises – demonstrably false – that go without saying, that must be accepted as truth: that America’s esteemed and trusted medical Institutions and professionals generally operate as driven by competence, principle, and ethical commitment to the safety and best interests of those whose lives and well-being they are responsible for protecting – that is, grounded in pure constructed fantasy that is cowardly and lethal.
Fantasy of the type that allowed creation and enables perpetuation of a worsening opioid and other substance use crises.
BELOW: CBS report –
“Doctors rush to use Supreme Court ruling to escape opioid charges”
And from an upcoming post –
In progressive Oregon, a state with the highest rate of seniors hospitalized for opioid overdoses, abuse and dependence and the sixth-highest percentage of teenage drug users in a 2018 audit, medical prescribers aren’t changing much about their opioid prescribing.
The program requires pharmacies to file information about prescriptions of controlled substances. Prescribers are supposed to register so state officials can identify excessive prescribers. Prescribers also search the database to identify patients who “doctor shopped” to obtain more prescriptions than they need.
But Oregon providers are not required to check the database when they prescribe controlled substances, the latest audit said. This is something auditors recommended in 2018 and is common in other states.
The audit identified patients with opioid prescriptions from “excessive numbers of prescribers” and “dangerous prescription drug combinations,” which includes mixing opioids such as OxyContin with sedatives, like Xanax.
It also said that state laws prevent the database from being shared with health licensing boards and law enforcement to monitor and address questionable prescription activity, another area of concern.
“Questionable prescribing habits seen within the data, even those that are egregious, cannot be elevated to any regulatory or enforcement entities to directly look into those situations,” the 2018 audit said.
The Oregon Health Authority, overseeing Oregon’s use of Measure 110 decriminalization funds for substance use treatment improvements, responded to the concerns without indications of commitment to action –
“The agency is pleased with the performance of the (program) in ensuring appropriate use of prescription drugs, and helping people work with their health care providers and pharmacists to determine what medications are best for them,” the statement said.
But the agency will not play a major role in pursuing legislative changes.
That is, LMP use of this important tool for protecting public health and moderating American Medicine’s worsening opioid crisis, whether voluntary or mandated, is not happening. And in a state like Oregon, legislative and healthcare oversight regulators are essentially providing LMPs protection from consequences for failing to modify prescribing to those ends. As has the U.S. Supreme Court.
The remarkable, interlocking protections
for continuing lethal medical prescribing that include compliant and colluding fabrication and distractions by medical research institutions, by America’s watchdog Press, by popular culture and media, by regulators, and by legal systems have, from emerging evidence, reached a triumphant immunity for opioid misprescribing.
Dr. Nelson Onaro conceded last summer that he’d written illegal prescriptions, although he said he was thinking only of his patients. From a tiny, brick clinic in Oklahoma, he doled out hundreds of opioid pills and dozens of fentanyl patches with no legitimate medical purpose.
“Those medications were prescribed to help my patients, from my own point of view,” Onaro said in court, as he reluctantly pleaded guilty to six counts of drug dealing. Because he confessed, the doctor was likely to get a reduced sentence of three years or less in prison.
But Onaro changed his mind in July. In the days before his sentencing, he asked a federal judge to throw out his plea deal, sending his case toward a trial. For a chance at exoneration, he’d face four times the charges and the possibility of a harsher sentence.
Why take the risk? A Supreme Court ruling has raised the bar to convict in a case like Onaro’s. In a June decision, the court said prosecutors must not only prove a prescription was not medically justified ― possibly because it was too large or dangerous, or simply unnecessary ― but also that the prescriber knew as much.
. . . In the three months since it was issued, the Ruan decision has been invoked in at least 15 ongoing prosecutions across 10 states, according to a KHN review of federal court records. Doctors cited the decision in post-conviction appeals, motions for acquittals, new trials, plea reversals, and a failed attempt to exclude the testimony of a prescribing expert, arguing their opinion was now irrelevant. Other defendants have successfully petitioned to delay their cases so the Ruan decision could be folded into their arguments at upcoming trials or sentencing hearings.
David Rivera, a former Obama-era U.S. attorney who once led overprescribing prosecutions in Middle Tennessee, said he believes doctors have a “great chance” of overturning convictions if they were prohibited from arguing a good faith defense or a jury was instructed to ignore one.
. . . But in writing the opinion of the Supreme Court, then-Justice Stephen Breyer insisted the burden of proof should not be so simple to overcome, remanding both convictions back to the lower courts for reconsideration.
Because doctors are allowed and expected to distribute drugs, Breyer wrote, prosecutors must not only prove they wrote prescriptions with no medical purpose but also that they did so “knowingly or intentionally.” Otherwise, the courts risk punishing “conduct that lies close to, but on the permissible side of, the criminal line,” Breyer wrote.
Breyer wrote, prosecutors must not only prove they wrote prescriptions with no medical purpose but also that they did so “knowingly or intentionally.”
That’s reasonable, isn’t it? Because America’s licensed, trained, and ethically practicing medical professionals would simply not do that – would not ever knowingly contribute to the risk and predictable dependence and deaths in a worsening epidemic fueled by prescribed opioids.
From an upcoming post –
Not a single opioid pill provided to living or dead Americans
was supplied to them by a member of the Sackler family, from Purdue Pharmaceuticals, from any employee of a pharmaceutical or opioid manufacturing company.
Apart from anomalous exceptions, like Sam Quinones’ unflinchingly “True Tale” in Dreamland – and a new piece in Journalist’s Resource, below – you wouldn’t get that from the necessary fabricated distortions and media focus on Big Pharma as criminal accomplice in the epidemic. As if those representatives and executives themselves were distributing the addictive Schedule II opioids, against evidence – all longstanding lines of relevant evidence – predicting harm, as if the pharmaceutical reps and execs were in the exam rooms, coercing MDs and other licensed medical providers, or forging their signatures on the prescriptions.
As if those licensed medical providers, over the course of an American medical education, would not have necessarily become aware of the evidence and their clinical and ethical obligations to practice accordingly, based on the longstanding indications against the runaway provision of those Schedule II opioids: the potential for hyperalgesia; the addictive potential of opioids; the lack of evidence for effectiveness; the psychogenic nature of common chronic pain; and the effective, durable, indicated use of cognitive behavioral therapy (CBT) for common chronic pain.
All lines of evidence that were established prior to generation of the opioid crisis and would have been part of any legitimate medical training, training that would have – one presumes – been taken as more compelling than the assurances of pharmaceutical representatives. Or not.
Sam Quinones, Chris McGreal in American Overdose, and some others have outlined the sordid confluence of forces –
deception, fabrication, submission to pressure from patients and medical organizations, and failed responsibility to vulnerable, trusting Americans – driving generation of the lethal opioid epidemic: a remarkable abdication of competence, integrity and ethical behavior by players including big pharma, America’s top medical, oversight, and research institutions, and the medical profession, with mass media along for the ride.
As McGreal describes in American Overdose, the clinical environment in medical practice settings became coercive and toxic – a collusion of patients trained by decades of programming to seek a pill for every distress including opioids, supported by the medical/hospital/insurance industrial complex to report doctors who would resist providing opioids inappropriately and threaten them with complaints and action by professional and licensing boards.
McGreal talked to Dr. Charles Lucas, a surgeon in Detroit who resisted growing pressure to overprescribe opioids, ended up being subject to a complaint and summoned before a hospital ethics committee for failure to provide adequate pain treatment.
(from American Overdose pp 88 – 89)
The case was dropped, but it was not an isolated incident. Luca has worked closely with another surgeon, Anna Ledgerwood, since 1972. She too was hauled before the ethics committee on more than one occasion on the same charge. One of the investigations, for alleged inadequate pain management after a hernia operation, went all the way up to the state medical board. It cleared Ledgerwood, but Lucas said more junior surgeons buckled to the pressure to administer opioids just to stay out of trouble. “If they will give me a hard time, then they will surely give a young resident a harder time,” he said. “I tend to be a fighter. That’s my nature. But somebody who just wants to take care of patients, they want to be a professional physician, they don’t want to put up with all this crap; they’re intimidated. They’re also frustrated by it. The medical community knows that too many pain medicines are being written. Doctors talk about it among themselves. They’re not in a position to challenge the system. But they know.”
Lucas regarded the new pain orthodoxy as a growing tyranny, and he thought it was killing patients.
Of course they knew. Or should have, or should not be practicing medicine.
But the forces driving runaway, medically inappropriate dispensing of opioids were not knowledge, competence, integrity or professional courage. There were other forces at play.
Quinones spilled the truth, more directly, as part of a cover story in the LA Times, when he noted, simply, that
Doctors told me they misprescribed the addictive opioids – Schedule II Controlled Substances – knowing it was medically not indicated.
Right, they disclosed the obvious which must be covered, hidden – the purpose of the cowardly LA Times Op-Ed.
Again, from Chris McGreal’s “American Overdose” –
“The medical community knows that too many pain medicines are being written. Doctors talk about it among themselves. They’re not in a position to challenge the system. But they know.”
Lucas regarded the new pain orthodoxy as a growing tyranny, and he thought it was killing patients.
The licensed prescribers I worked with in a primary care medical clinic were less fearful of “the system” than of trying to explain the need to taper patients down off high-dose courses of opioids inappropriately prescribed – prescribed for common chronic pain. They didn’t like the confrontation. The system – Oregon’s health authority and managed care organizations – was behind them. Behind them until pressure from doctors, medical groups, and patient groups dangerously misusing opioids – chronic pain patients – learned to use bullying to shift public health policy back to high-risk opioid prescribing practices, with the predictable outcomes noted above, in this post.
The Supreme Court ruling removes the only remaining deterrent
to dangerous, indicated-against opioid prescribing. How many of America’s licensed prescribers, in a population whose prescribing has been driven by fearful bending to intimidation or by graft – instead of preserving career and avoiding criminal charges with the easy lies (“Yes of course I believed it was in the best medical interests of my patients to be provided those doses for the intractable pain they were describing.”) – will under oath tell the truth? Will perceive significant risk for not telling the truth? The truth that, “Yes, of course I knew it was risky for the patient and indicated against. We all knew it. We talked about it”.
That is to say, in its decision, the Supreme Court has normalized and protected the generalized behaviors – of professionals entrusted with the health and well-being of their society’s vulnerable – of knowingly prescribing addictive, potentially lethal drugs driving an increasingly lethal epidemic, out of cowardice, of fear of losing their standing, esteemed position, or salary. Knowingly and out of cowardice as an inhibitor of obligatory ethical and professional conduct. Cowardice and common graft.
Those are the potentially lethal behaviors threatening public health the Court knowingly and unanimously protected with their ruling. WIth their cowardice and fealty to institutional power and constructed authority.