Last Friday, for the first time ever, a physician was convicted of second-degree murder for recklessly prescribing pain-killing drugs to patients. Dr. Lisa Tseng was sentenced to 30 years to life in prison by a Los Angeles County Superior Court judge for her role in the overdose deaths of three young men, each who whom had been given prescriptions for large amounts of opiate-based painkillers and other potent narcotics despite having no medical need.
Although the defense tried to paint Dr. Tseng a well-meaning but naïve physician who was taken advantage of by manipulative and drug-seeking patients, in fact she ran a lucrative but criminal “pill mill” out of a seedy Southern California strip mall. She earned over $4 million a year by writing prescriptions for addictive drugs like Oxycontin and hydrocodone without performing the necessary medical exams.
Dr. Tseng is not the first physician to be arrested for running a “pill mill”. In 2014, for example, nearly two-dozen clinicians were arrested in New York for prescribing addictive narcotics to patients who didn't need them. That small handful of physicians alone had prescribed more than 5 million doses of oxycodone, a powerful and highly addictive narcotic.
Just last year, agents with the federal Drug Enforcement Agency (DEA) conducted the "largest pharmaceutical-related bust” in that agency’s history. Nearly 300 people, including 22 doctors and pharmacists, were arrests and charged with conspiracy as part of a multi-state scheme to illegally distribute painkillers and other addictive drugs.
Unfortunately, these arrests and convictions will probably do little to stem the disastrous flood of prescription drug abuse that is currently washing over communities across America.
While it is tempting to argue that corrupt doctors like Tseng are responsible for the current epidemic of prescription drug abuse, they are only one strand in an incredibly complex and tangled web of addiction that dates back decades. The problem itself actually started in 1995, when the US Food and Drug Administration first approved long-lasting opioid drugs like OxyContin. Those drugs revolutionized the way in which pain was clinically managed in the United States, allowing patients with severe and unremitting pain to get much needed relief.
Prior to OxyContin’s approval by the FDA, chronic pain – a highly subjective symptom that can vary substantially from one individual to the next – was grossly undertreated. Physicians were often reluctant to prescribe pain-killing drugs like Vicodin, which had to be taken several times a day, out of fear that their patients would quickly become addicted. Since OxyContin only needed to be taken once or twice a day, physicians were far more comfortable in prescribing it. That, coupled with heavy promotion by pharmaceutical representative, meant that sales of it and similar painkillers quickly skyrocketed. A few years later, so did rates of addiction and subsequent overdose deaths.
So serious is this epidemic – and the interrelated heroin epidemic – that drug overdose has become the leading cause of injury-related death in the US. This year, more people will die from a drug overdose (usually involving an opioid prescription painkiller like Oxycontin) than will die in an automobile accident. Given the magnitude of this problem, it is not surprising drug abuse was a hotly debated issue in last week’s Republican and Democratic Presidential debates. Nor is it surprising that the Obama Administration has proposed spending over $1 billion on new initiatives to combat the problem.
That said, we have already made some headway in tackling this problem. In recent years, for example, state and federal drug enforcement agencies have begun to crack down on the use of these pain medications. In 2012, the New York State legislature passed the Internet System for Tracking Over-Prescribing (ISTOP) Act. That Act required the New York State Commissioner of Health to create a drug database in order to crackdown on the over-prescription and abuse opioid painkillers like OxyContin. Nearly every US state now has a similar drug -monitoring program, which can be used to identify and suspend the prescribing rights of doctors believed to over-prescribe these highly addictive drugs. As a result, the rate of prescription drug abuse has finally stabilized and the number of overdoses has actually dropped slightly in recent years.
The conviction of Tseng and prosecution of others like her for second-degree murder will contribute little to these efforts. However, high-profile criminal cases like these may have a chilling and retrograde effect on the way in which we treat patients with chronic pain. Physicians, particularly those that specialize in pain management, are already under increased scrutiny as a result of programs like ISTOP. If they begin to worry that they could face criminal prosecution for prescribing drugs like OxyContin, they may start to limit the amount of powerful painkillers they give to patients, even to those who have a medical need for them.
We may soon learn that cautious steps that we have made in recent years towards more effective treatment and management of chronic pain in this country are for naught. It is important to hold callous physicians like Tseng responsible for their actions, but we shouldn’t deceive ourselves into thinking that these trials and convictions will make even the smallest dent in the prescription drug abuse epidemic. While these trials bring justice to the families of those who were harmed by the doctors and pharmacists who run pill mills, they may come at great cost to those who suffer from chronic pain. We need to find a more appropriate balance by creating laws and policies that prevent addicts from gaining easy access to drugs like OxyContin while still ensuring that doctors feel secure enough to prescribe them to those in pain.
A public health researcher and ethicist by training, Dr. Sean Philpott-Jones is Director of Research Ethics for the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of the Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.
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