The U.S. Supreme Court has agreed (Reuters, March 1, 2022) to review the convictions of two physicians who sit in jail cells after opioid convictions. These were not “country doctors” who prescribed a vial or two of pain-killing medications to a person with intractable pain, but men accused of running “pill-mill pain clinics” for fun and profit.
The two physicians are arguing under what circumstances they can “be convicted of operating as drug dealers under the cover of their medical practices to illegally distribute opioid painkillers and other dangerous narcotics.”
One of the physicians practiced in Alabama and the other in Wyoming. Their contention is that “(the) jurors convicted the doctors of unlawfully dispensing massive amounts of opioids through ‘pill mill’ clinics without having to weigh whether they had a ‘good faith’ reason to believe their prescriptions were medically valid.”
Slippery Slope
Let us not forget that the physicians were convicted of violating the Controlled Substances Act. They were essentially handing out dangerous opioids like candy. The pills that were dispensed through hundreds of dubious (at best) prescriptions were in excess of any logical dosage. “Pill-Mills,” illegal compounding pharmacies, general pharmacies and unethical staffs working at established practices, have managed to annually addict hundreds of thousands of “patients” each year to opioids. This has resulted in tens of thousands of annual deaths.
The question the U.S. Supreme Court is being asked to review is the standard by which prescriptions can be written. I must say that from an ethical point-of-view, I agree with U.S. Deputy Solicitor Eric Feigin who feels the doctors’ arguments would upend the purposes of licenses issued by the U.S. Drug Enforcement Administration:
“They want to be free of any obligation even to undertake any minimal effort to act like doctors when they prescribe dangerous, highly addictive and, in one case, lethal dosages of drugs to trusting and vulnerable patients.”
Here are where “legal arguments” must take a back seat to ethical behavior. Frankly, I tire of the slippery slope of legal rambling and nuance. At the heart of these arguments is the inescapable reality that the doctors in question have been sentenced to 21 and 25 years. These were the consequences of their addicting and in one case, killing a “patient” with opioids.
So, one might argue what about the thousands of physicians who prescribed opioids with extreme caution for patients in severe pain? Why aren’t they in jail? The difference, of course, is a sense of medical responsibility. They had a grasp on what they were doing and conditions under which a powerful and potentially addictive painkiller could be prescribed.
For them, the good faith argument, the argument of “Well, I gave this guy 50 pills a week in good faith,” does not hold up. Why should it? Indeed, what is “good faith” to a physician anyway?
Pill-Mills for Profit
The pill-mills or any other illegal form of dispensing opioids, were no different than other scams and frauds. In this case, the physicians believed that their medical licenses lent them an invisibility. They were (in their minds) free to act without oversite. Once they issued a prescription, directly or indirectly through a surrogate, they believed they were unseen as well as invulnerable.
The need of these monsters was simple: cash. And, they made millions. Opioids are extremely powerful in their chemistry. They understood that an addict would lie, steal, cheat or commit violence to score more drugs. Where – or how – the dealers or addicts found the money to pay the clinic was never their concern. They raked in millions, all in “good faith.”
How could a physician rationalize addicting people for profit? This, to me, is the most insidious observation of all. I believe the physicians stopped seeing them as people (let alone as patients), and saw them as addicts who were medically unsalvageable. In other words, the whole point of licensure and of becoming physicians was lost to greed.
There are choices and consequences, and I doubt that even an appeal to the U.S. Supreme Court will change the outcome.
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