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Will fear of prescribing opioids fuel illegal addiction?

As the Supreme Court begins to look at a liability case of two physicians already found guilty of pill peddling hundreds of thousands of opioids, doctors are becoming increasingly reluctant to prescribe opioids for pain treatment for fear of being criminally charged in the future, according to an analysis by Bloomberg Law.

Because of this, experts worry that the future of treating pain in America will drastically change — possibly exacerbating addiction and drug use in the criminal field if an individual isn’t able to get relief through a legal and regulated channel.

According to the Department of Justice, Dr. Xiulu Ruan was one of the nation’s top prescribers of quick-released fentanyl drugs, dispensing over 300,000 prescription painkillers from 2011 to 2015, the New York Times details.

Ruan has been serving a 21-year sentence in federal prison, and Dr. Shakeel Kahn, who was similarly convicted in 2019 for his part in a massive prescription drug conspiracy, is carrying out his 25-year sentence for distributing millions of opioids, K2 Radio details.

Both men’s fate behind bars now hinges on just how far justices believe the government should go into proving criminal intent — ”a thorny issue at the divide between substance use disorder and the need to treat pain,” the New York Times writes. 

‘Medical climate’

While the Supreme Court decision is not expected for another few months, many physicians and legal advocacy groups warn that if the justices rule in such a way that creates a “medical climate” where doctors fear incarceration for prescribing appropriate pain treatment.

“If we are closing our doors to patients who have been on long-term opioids or need opioids for their pain, then we’re essentially asking our patients to find pain relief outside of the medical system,” Pooja Lagisetty, a physician investigator at the University of Michigan, told Bloomberg Law. “We’re essentially asking them to go into an unregulated system that could be more harmful.”

Overdoses in America have been climbing in recent years, particularly during the pandemic. Estimated annual overdose deaths topped 100,000 in the 12-month period ending in April 2021, the Centers for Disease Control and Prevention detailed, uncovering an up-tick from about 48,000 in the 12-month period ending in January 2015.

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Much of the opioid overdoses fall on the shoulders of Black and Latino Americans, UCLA Newsroom and Axios reports.

Ryan Hampton, an advocate and author, attributes being “abruptly cut off by a doctor” with his prescribed pain killers as driving his own battle with addiction.

“Within 10 minutes literally, I was using heroin,” Hampton told Bloomberg Law.

A self-described “victim of pill mills for many years,” Hampton tells reporters that he blames the increased threat imposed on doctors, and the lower access to treatment with the ever-changing federal prescription guidelines, which ignore that while “some people need little to no opioids, others need more, and doctors need to have the ability to make the determinations of what’s best.”

“It’s a delicate balance—the courts need to find the right medium between holding unscrupulous doctors accountable while not harming patients who rely on opioids for chronic pain management,” Hampton told Bloomberg Law.

Grappling with ‘physician intent’ and doctor fear

Even if in the majority of cases, medical professional incarceration only threatens “a small minority of egregious pill pushers, the fear of it happening to somebody that is appropriately prescribing is still there,” Lagisetty said, shining a light on doctor fear that hasn’t been widely discussed.

The importance of this case and the underlying issue — the opioid crisis — cannot be overstated, particularly as the concept of physician intent is argued regarding whether or not to take a nuanced topic and set rules regarding legitimate medical prescribing or facetious medical malpractice, SCOTUS Blog details.

Medpage Today, a medical news outlet that posts national and international news, has already begun reporting to readers the importance of making judgment calls when prescribing addictive painkillers, detailing how the current justices are grappling with the question of reasonable professional practice, “which can be difficult to pin down in medicine.”

Other doctors are on high alert, with some rethinking their relationship with prescribing pain killers to begin with. 

“Any doctors aware of what happened to Dr. Ruan will say, ‘hey, I’m not touching these controlled substances,” Jane Orient, a physician and executive director of the Association of American Physicians and Surgeons (AAPS), told Bloomberg Law. AAPS also filed a Supreme Court brief calling Ruan’s 21-year sentence “tyrannical.”

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Overall, while the justices debate the developing case, advocates are left to wait to feel the impact.

“It’s incredibly important that they get us right,” Hampton said. “What they determine in this case will be a standard to be used for decades to come.”

This report was first published by The Crime Report.

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