According to the CDC in 2010, over 22,000 drug overdose deaths in the United States were related to pharmaceuticals, accounting for 60 percent of all overdose deaths. The problem of prescription drug abuse still continues, and experts, researchers and politicians are trying to find the best approach to reducing the damage done by the substances. Of course, prescription drugs ultimately come from doctors, and with such a large number of overdoses, it’s only natural to ask whether the doctors are to blame. Looking at the issue in more detail—through celebrity cases and the infamous “pill mills”—helps you understand the problem more closely before laying the blame at the feet of physicians. 

Celebrity Prescription Drug Overdose Deaths

The issue of doctors’ level of responsibility is well illustrated in the death of pop superstar Michael Jackson in 2009. His autopsy revealed that the star was killed by an injection of the sedative propofol, and that he’d also ingested a cocktail of pills, including eight lorazepam (an anti-anxiety, anti-insomnia medication) on the night of his death. In the end, his physician, Conrad Murray, was charged with involuntary manslaughter. However, the case was a bit more complex than an ordinary doctor-patient relationship: Murray spent six nights per week at Jackson’s house, and the star had consistently begged him for sleeping medication, he said. Although his lawyers maintained that Jackson gave himself the lethal shot, Murray was sentenced to two years in jail and had his license suspended in California and Nevada and revoked in Texas.

Another case with a less-famous musician, Slipknot bassist Paul Gray, had the opposite conclusion. The rock star died from an overdose of morphine and fentanyl, and his doctor Daniel Baldi, was charged in his death. With four malpractice claims and three wrongful deaths suits already to his name, Baldi was charged with another seven counts of involuntary manslaughter, one of which was for the star’s overdose. The basic argument was that Gray was a known drug addict, and the physician continued to prescribe him the medication that ultimately led to his death. In this case, however, he was cleared on all counts.

Dodgy Doctors and Pill Mills

Stories like this aren’t limited to celebrities, of course, and any physician tied to a large number of overdose deaths is open to suspicion. Some operate out of what are known as “pill mills” — pain clinics that employ registered but morally questionable physicians to dole out prescriptions of potentially lethal medications. These operations do attract legal consequences, however: an example is Christopher George, who was sentenced to 17 years in jail for operating several Florida pill mills. According to the presiding judge, he was unrepentant, but had a few years cut from his sentence for helping the courts prosecute some of the doctors from his clinics. However, two physicians who worked for George were cleared of charges relating to the deaths of eight patients, instead receiving sentences for charges of money laundering.

Role of Doctors in OD Deaths

The Los Angeles Times conducted an investigation into this issue in 2012, looking at 71 doctors who’d prescribed drugs to three or more patients who died from an overdose in the previous five years. Four of the doctors had prescribed medication to 10 or more patients who died of an overdose, one of whom was Dr. Van H. Vu, who prescribed medicines to 16 patients who later overdosed.

A recent study from the CDC looked at the sources of prescription opioid medicines for regular users, who took pills at least 200 days in the previous year. The CDC found that 27.3 percent of these regular users got their drugs from physicians, making it the most common source of the medicines just ahead of family members and friends, and a considerably more common source than dealers, who supplied to just 15.2 percent of the sample

Are Doctors Really to Blame?

Although it’s clear that doctors are instrumental in many prescription drug overdoses, it’s essential to remember that it’s their job to prescribe such medicines to patients in need. Drug-seekers may mimic symptoms, but pain is difficult to judge objectively so it’s understandable that some doctors would unintentionally supply medicines to abusers. That said, there are clearly some physicians who undoubtedly are aware of the likelihood that the prescription they write could result in overdose and do little to attempt to remove or minimize that possibility.

The best approach, as Len Paulozzi from the CDC’s Center for Injury Prevention and Control argues, is assessing each incident on a case-by-case basis, and prosecuting when laws are clearly broken or the physician obviously behaved fraudulently. Coming up with a hard-and-fast rule risks limiting access to much-needed medications for patients in genuine need of pain control, but doing nothing would allow unethical prescribing practices to continue unchecked. It may not be the easiest way to rectify the issue, but it’s a complicated problem with potential consequences when any mistakes are made. It seems like the complicated question will have to be answered by many judges across the country for some time to come.

Continue Reading: