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Subscribe to RSSLast June 19, four people died in a brutal massacre in a drugstore on Long Island. After getting a 911 emergency call, Suffolk County homicide detectives found four people shot dead at Haven Drugs in Medford, 60 miles east of New York City. Addiction to prescription painkillers played a key role in this horrible event.
Now the family of one of those killed is calling the doctors who prescribed drugs for the convicted murderer to account. Antonia Mejia, mother of the youngest victim, 17-year-old Jennifer Mejia, has filed a lawsuit alleging negligence on the part of Stan Li, Eric Jacobson and Mark Kaufman, all doctors who allegedly wrote pain med prescriptions for the killer.
She is right to pursue this novel legal strategy.
Jennifer, who worked at the store, pharmacist Raymond Ferguson, 45, and two customers, Jaime Taccetta, 33, and Bryon Sheffield, 71, were shot dead by David Laffer. He walked into the drug store last Father’s Day, minutes after it opened, and rapidly shot the pharmacist, Jennifer and the two customers at close range. He then filled up a backpack with 10,000 prescription painkillers and fled. All of this was caught on the store’s video recorder.
Suffolk County Police Commissioner Richard Dormer said, “In all my law enforcement experience and in the experience of the police that are involved in this investigation, this is one of the most heinous, brutal crimes we have ever encountered.”
Laffer was quickly caught and convicted. It became clear during his trial that he had a long history of addiction to painkillers and an equally long history of doctors prescribing drugs to him.
The abuse of pain medication in the U.S. is out of control. While illegal street drug use has declined, abuse of prescription medications, especially painkillers, has been increasing. Emergency department visits for nonmedical use of opioid analgesics climbed by 111 percent between 2004 and 2008, and jumped nearly 30 percent between 2007 and 2008 alone, according to a 2010 report by the Centers for Disease Control and Prevention.
Who is partly to blame for this mess? Certainly some doctors should be. The key source of painkiller abuse is the medical establishment. A few bad apples prescribe painkillers to anyone who comes in the door, often giving them multiple prescriptions.
Jennifer’s mother has no doubt about the role played by doctors in feeding the drug habit of Laffer. She told the Long Island newspaper Newsday, "The main reason we came to this point [filing a lawsuit] is because the doctors fed his [Laffer's] addiction -- they know what they are creating when they write these prescriptions."
There will be an impassioned defense by the doctors named in the lawsuit. It may turn out that they did nothing wrong in prescribing for Laffer. But there are reports of docs who write scripts for cash for pain pill addicts, though those are, admittedly, rare. It may also turn out that Laffer is partly a creation of bad medicine.
Not so long ago, the world focused in on the role played by Michael Jackson’s personal physician, Dr. Conrad Murray, who was found guilty of involuntary manslaughter after giving Jackson the dangerous and powerful anesthetic propofol to help him sleep.
It is long past time to move past the odd celebrity physician case and hold doctors accountable for the damage they do in misprescribing far less exotic drugs than propofol.
If we can all spend so much time and energy worrying about and hoping for justice for the Conrad Murrays of the world, shouldn’t we create a public policy and legal doctrine that hold accountable those doctors who prescribe these potent painkillers indiscriminately?
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.
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Leave a Comment:
Well-written article, but this opinion piece doesn't mention the unfortunate backlash of such prosecution - that it will undoubtedly make physicians less likely to prescribe such medications, and therefore make it more difficult for those who actually DO need them to get them. The primary issue with the treatment of pain is that there is no infallible test for its presence - the physician must eseentially trust the patient's own report. As a physician I can honestly say that there is ALREADY a pervasive, almost immediate distrust of anyone requesting pain medication even without such prosecution. This 'default' lack of trust serves to limit horrific cases such as those described above, but it already makes it incredibly difficult for those suffering with real pain to receive appropriate and timely care, because the default position has become to not trust people asking for pain relief. Be wary of making this even worse!
Agreed - As tragic as this case is, the overall trend in America is under-medication of painkillers due to the litigious nature of out health care system. Sure people will get some kind of pain medication, but it is often not enough to actually reduce let alone stop the pain which can be debilitating in a number of illnesses.
There will always be horrific events and many factors can come into play: childhood, drugs, Twinkies. But unless you show me some solid studies that increasing the risk of doctors to practice medicine will actually a) reduce drug abuse that actually negatively impacts society in a solid way and b) that doesn't result in the under-treatment of legitimate pain then it's better to do nothing at all then make things worse.
the drug war has turned into the war on doctors
Emily - Agreed - As tragic as this case is, the overall trend in America is under-medication of painkillers due to the litigious nature of out health care system.
You are being sarcastic aren't you. If not please do a little research on the actual rates of prescription use for these drugs. Under medication? Not even close.
johnr123-3235782m you wouldn't, you literally, COULDN'T, make that claim if you or anyone close to you is a chronic pain patient.
Chronic pain is a symptom of every chronic illness, to one extent or another. And finding appropriate pain management is insanely difficult (perhaps YOU'd like to try living with three different types of arthritis, as I do), and made more so by irresponsible people on both sides of the doctors' desks. Josephus may be sitting the the "driver's seat" on this issue (he's the one writing the scrips), but he's absolutely correct, as is EmilyinIowa. I suspect that she, or someone very close to her, is also a chronic pain patient.
I know in my own experience that my own doctors are almost terrified of writing prescriptions for pain pills no matter how much pain you are in and they know it. Unless they can justify it from either broken bones or surgery you might as will forget it as they are afraid of getting in trouble. I am not at all pleased with that because during the times I have a bad flare up of unbelieveable pain caused by previous surgeries that didn't heal correctly the only relief I can find is going to bed with a heating pad for a few days. I can't go to work or function at all and that isn't right. So,there are a lot of us that are already paying dearly for the few that are causing the problems. If they crack down on doctors anymore I can't even imagine the damage that will do to the people that really need help. The rate things are going evrything in this country is going to be regulated to the point that none of us will have any rights left.
You are so correct. I have met two doctors who have told me in confidence that they have not written drugs for people who are exhibiting drug seeking behavior and that they are terrified that they will get sued. Their peers are writing the prescriptions rather than spend all their time and money on the lawyers who will say that the doctor had no right to cut off their client's pain drugs. On the other hand, they have extreme sympathy for those who are in chronic pain, have no insurance and cannot afford to go to a "pain clinic" to meet the new Florida rules about who can prescribe what to whom. In the case of Florida, the baby got thrown out with the bath water.
Sherala-
Don't understand why you don't just change doctors? Seems yours is a bit extreme. Something just doesn't sound right...
Correct. I have a friend who needs his hip replaced sometime in the fairly near future. His MD refuses to prescribe pain meds for him, until he HAS the surgery. He'll give my friend pills for the post op pain, but not for the fact that right now, he has bone on bone
Caplan - The use of an inflammatory title and projecting blame on the
prescriber reduces this piece to a meaningless diatribe that was written and
published for no discernable reason. We are just emerging from an era when
people who were in obvious pain were given no more than Tylenol (an almost
useless drug). Cancer patients who had less than 6 months to live were expected
to contend with the pain even though opiate derivatives were readily available
to them at a cost of less than $.25 per dose. In the past 10 years we have seen
a shift in pain management strategies and it is long overdue. The gangsters who
shot the pharmacy staff are social deviants. If they hadn't
robbed the pharmacy they would have done something else outrageous like raiding
a cocaine stash house. We need a rational approach to pain management. We must
be able to extend compassionate care to those who for whatever reason,
experience pain.
johnr123-3235782
No, I wasn't being sarcastic. Doctors are put in a position where they feel it is better to error on the side of their patient suffering then losing their license to those addicted. In my opinion I would rather error on the side of a some high-seeking individuals getting prescription drugs if it means patients with chronic pain getting proper treatment.
Let's see... there's a drug test they can have the patient take before they prescribe the meds, that'll make them run for the door.
I take several pain meds, strong ones, all prescribed and have been on them a long time. I don't know what I'd do without them for my constant pain. I get drug tested whenever my doctor wants one and I won't get my meds without it. Had to sign a contract, can't get drugs from another doc which I know is the problem. I guess I'm just one of those that follow the rules regarding them because it's the only thing that will help me deal with my chronic pain.
Yes, the docs need to be held accountable, but that's actually pretty easy. They just need to stick to it.
It seems these days that there is
nothing a doctor cannot get sued for. Furthermore, the people that malign
doctors for having a “god complex” are ironically the same people that expect
doctors to be clairvoyant, omniscient, omnipresent, and omnipotent. When it comes to prescribing pain medication to
a patient, it is frequently near impossible to discern a patient that is having
real pain from the addicted patient that “knows all right moves.” Yes, it would
be easy if every drug seeking pt walked into the office saying “give me Percocet
doc” but, many walk in displaying all the right signs symptoms of a patient in
pain. What do you expect doctors to do; distrust every pt that comes in with
pain, “run drug tests” on every patient before they prescribe narcotics. Not
only would this ruin many doctor-patient relationships and result in the undertreating
of patients that are truly in pain, but it would also exorbitantly drive up the
cost of healthcare. What if the patient tested positive for marijuana – “I’m
sorry Mr. Jones, I know you’re in excruciating pain but, I can’t help you until
you stop using marijuana.”
Fortunately, there has been some
help in curtailing the over-prescribing of narcotics. Some pharmacies have the ability
to track how many narcotic prescriptions a patient has been getting over a
period of time. However, many drug-seeking patients have become wise to this
and go to different pharmaceutical chains and smaller family pharmacies.
Seriously, what do you expect doctors to do: track down and call every physician
and pharmacy that a patient has been to and double check. This would take hours
not to mention that the drug seeker would not voluntarily give out this
information. Seriously, should doctors be responsible for every single action one
of their patients makes?
Blame big pharma. There is a pain killer out there without all the addictive and side effect laden problems, it's marijuana. I ruptured my quad tendon in my knee a year ago. After surgery to reattach it the surgeon sent me home with two prescription pain killers. After refilling each once at a unbelieveable cost I just toked a doobie. No pain, no side effects, no addiction, no insurance to deal with and it was more effective against the pain. Plus I actually slept.
As a recently graduated physician, I can tell you the patient I fear the most is those with chronic pain seeking narcotics. Most of these people are truly in pain, but it is so hard to tell real pain from abuse, and the lines often blur. I'm seriously considering not prescribing them at all, and I know some physicians who do just this. I didn't go to medical school to feel like a drug dealer or get sued.
Sure, there is the rare doctor who prescribes an unsafe amount of narcotics and/or actually takes cash payments for it, but most are just trying to help their patients. I hate that every move I make as a doctor has to consider covering my butt legally.
And I don't appreciate the author of this article saying that the plaintiff is "right to pursue this novel legal strategy". I'm sure that was this devious doctor's plan all along to get the patient addicted to pain killers and have them gun down innocent people. How absurd.
cpmed, you've got to be kidding about not prescribing them at all. I worked in nursing in nursing homes, medical rehabs. and in hospitals. You weren't taught about "Pain Management"? There are doctors who deal with that because yes some people are in continual chronic pain. But we are talking about something else entirely here. I've watched doctors turn 80 year olds into to addicts, 70 year olds turned into addicts because they had hip replacement in nursing homes and it has to do with the WAY the doctor writes the script. I've seen them become addicted within a week and they (the patient) didn't realize it nor the families.
I've watched doctors in hospitals let patients tell them about phantom pain and just automatically reach for the prescription pad without thinking...how about a placebo? I'm not even referring to the "strip mall doctors" here. These doctors just allow a patient to tell them any thing and mindlessly reach for a pad. With mindless "thinking" it's frightening how many people in this country are prescription addicts and no these doctors weren't "selling" the prescription.
cpmed, and another thing why don't you appreciate the the plaintiff's right to peruse the doctors who continually wrote the prescriptions? That's how doctors in this country create the script addict. Try thinking about taking responsibility, the patient isn't forcing the doctor to write them---they are asking/whining for the prescription. So You need to back up and punt, it's the nursing staff in hospitals and nursing homes and in medical rehabs that actually spend more time with YOUR patient and can watch what you the doctor are creating. IT'S CALLED FOLLOW THE MONEY
allison,
before you start lecturing a physician about how to practice medicine, you should make sure you know what you are talking about. You have clearly demonstrated you do not
For example, the idea of prescribing a placebo to a patient is clearly unethical, and prohibited by medical guidelines
Secondly, are you a mind reader? How do you know the physician wasn't taking the history, physical exam, and lab/imaging findings into consideration when writing a prescription? Unless you have ESP, the answer is, you don't.
About a plantiff's right to pursue docs...what law are they breaking? I don't see an actionable claim unless some law
I thought america was a free country. We should legalize all drug use so people will get help like we do with alcohol and cigarets. Bring the drug use out of the dark so people will not try and hide their use and we will all have a better understanding of addiction and how to treat it. Imagine the police would be around to serve and help instead of harass and arrest. Then we would need more counselors and less police. the war on drugs/freedom is a war on freedom of choice. If you want to end this corruption legalize freedom of choice. If we teach them to understand their problem they might make the right choice. because we are losing the wart on drugs, and if we don't stop this war this war will never end on freedom of choice. stop trying to control people and try to work with the people.
This is absolutely ridiculous. Let's sue the DOCTORS... the people who save our lives every day, the people who studied for 8-10 years of their life to be able to do what they do. Let's blame THEM. Not the freaking drug addicts and their friends and families who enable them to do what they want.
Do you people even think? Next we'll be telling the addicts it's not their fault they're addicted, it's the doctors fault for giving them the pills that started their addictions. BUT WAIT, NOOO it's the PHARMACISTS MAKING the drugs that are to blame. They MADE the drugs that are addicting, let's SUE THEM!
Addiction is a choice, not a disease. Most addicts CHOOSE to be addicted because they don't want to deal with the pain of withdrawal. Rarely does the act of stopping an addiction kill someone. If there were no addicts we wouldn't even be reading this article. What ever happened to being accountable for your OWN actions? No one is FORCING the pills down your mouth. All you have to do is do your own research on your medications and if you know you're taking something addictive, ask to be prescribed something different. Honesty, it works.
Stop feeding the "It's not your fault" society. Man up for once and say "IT'S MY FAULT."
Next week on MSNBC: Let's blame teachers for our kids acting out because obviously it's their job to discipline them....
Folks, here are some of the issues:
1. If a bar tender keeps serving drinks to a customer, and this customer is considered drunk, the bar tender can be held liable for any injuries the person causes due to the bar tenders actions. A Dr's patient is a Customer. I completly realize there is a big difference in professions, but the actions are simular.
2. Over 100,000 people a year are injured or die due to Dr. errors. How often do you hear of any punishment for Dr. incompetence.
3. There are good Drs. and bad Drs. - Ask Micheal Jackson if he had a good Dr. The bad thing is even when a Dr. recognizes poor performance from another Dr. they seldom will turn in one of their own.
4. Drs who prescribe pain killers to a patient for a year or two must know that person is addicted. So what do they do - or what can they do?
Just some additional issues we need to think about.
Good points but...
1. This is pretty much the same situation, and is also just as ridiculous. These types of situations (especially for the doctor) present a catch 22 where they are damned if they do, damned if they don't. If the doctor doesn't prescribe, the patient screams "I have a right to be pain free" and if they do prescribe and the patient becomes an addict they scream "It's your fault, I'm suing" Who are we to put our lifesavers in this situation?
2. Sure, doctors make mistakes, but how many people are SAVED by doctors? How many of those people that ended up injured would be dead without the doctor in the first place? Let's see how society gets along WITHOUT doctors, then you'll be happy they are around.
3. I agree, there are good doctors and bad doctors. There is no need to punish the good ones for what the few bad ones do.
4. Yet if the doctor would say "I think you need to get off of this pain medication." the patient would complain and say something about their right to be pain free. Chronic pain often lasts longer than a year or two, what do you want the doctor to do? Happy patients write better reviews and refer people to that doctor more often.
Rado
I appreciate your counter-point - but are you being a little to idealistic or protective.
1. Yes I agree that the Drs are in a bad situation if they do - or do not prescribe medication. They have one of the most powerful comprehensive lobbies in Washington, why don't they change the law. A Dr. DOES NOT have any obligation to prescribe anything - regardless of how loud the patient screams.
2. Give me break. We all agree that Drs. save countless lives but let's not make them martyrs. Drs. are just people who selected a profession. It's redicuouls to think we could get along without them - but you could say the same for Engineers or numerous other professions?
3. No one ever said we should go after ALL Drs. But who goes after the bad ones? What's pathetic is the police force that scares the medical profession are the insurance companies. I also agree that we way over litigate medical issues.
4. Is a Dr. who prescribes pain killers to a person who they know is an addict guilty of anything???
Fundamentally, I agree with you and am sick of people trying to get rich from law suits. But that's the reality we've created.
This very much depends on the doctor. Sadly, some doctors are ridiculously prejudiced--where I live, my former doctor is deeply prejudiced against anyone who is not a conservative fundamentalist evangelical Christian. Everyone else is "drug-seeking." The definition of "drug-seeking behaviors" is so flexible that it is easily used to leave some people in pain while over-prescribing for others.
Part of the problem is that doctors cannot check to see what other meds patients are getting--and, yes, I think that patients should be tracked in some way to see what meds they are getting.
However, I have had a doctor refuse to give me pain medication until he saw an MRI, and then refuse to send me to a pain management specialist quickly, believing that the condition would resolve itself. Try spending five months not being able to lie down--kneeling on the bed, leaning forward, and clutching a pile of pillows to your chest so that you can sleep an hour or two. When I was finally sent to the pain management specialist--who was not at all surprised by the pain I was in and who prescribed me a non-narcotic "pain killer" (actually, it was some sort of anti-epileptic drug that did nothing for the pain, but did prevent spasms in my muscles which made it worse and also made me sleepy--I loved it), he offered quite freely to give me pretty much any meds that would make me feel better--because he already knew what kind of pain I was in.
I came back with praise for the pain management doctor because I was finally sleeping 4-5 hours a night . . . this dweeb had the gall to make a snarky remark about this was okay "if that was enough for me." I reminded him, pointedly, that I'd only been getting 1 to 2 hours a night before that. Of course, he rolled his eyes and turned away--drug-seeking behavior, I guess, out of me.
I really do not think that chronic pain is best managed with a narcotic--there are other things that can help such as acupuncture, massage, meditation, and so forth. Narcotics only cause a person to build up resistence, and when one finally has to give them up due to addiction, one is just that much more sensitive to the pain. However, in the short term, to give the person a chance to get a regimen started for that pain, then narcotics are needed.
If narcotic medication prescriptions were monitored for patients, it would not only make it possible for patients to prove that they weren't "doctor shopping," but it would make it possible for doctors who were giving out absurd scripts to be identified. Since narcotics can only be dispensed by certain means, it really isn't that hard to track it (if they can track pseudoepherine, and they do, they can track this).
A doctor who only sees a patient once might be a lot more likely to write a script than a doctor who is seeing a patient long-term. Abuse is easiest for those who see doctor after doctor at clinics or ERs. So, again, this really sounds more like an issue of tracking from the pharmacy--and patients really do need to be able to prove to prejudiced doctors that they actually are not drug-seeking and don't see doctor after doctor after doctor. Tracking seems the easiest solution.
frustrated,
I think you are missing some of the points
1. the AMA is certainly a powerful lobby, but not powerful enough that they can change laws at will. Witness declining reimbursements, and the "doc fix" that is perpetually put off by congress while the AMA clearly lobbies for a redesign of the payment scheme. In addition, a dr does not "have an obligation to prescribe a med" per se, but CAN be sued successfully if he ignores pain and suffering of a patient, and definetely if he does not prescribe life-saving medication. Now, the author of this article is advocating for suing drs on the basis of actively prescribing medication--where does it end?
2. Nothing you say here directly refutes any points stated earlier, nor is it really central to any argument
3. The DEA certainly has charged physicians with narcotic distribution, and the federal govt has charged a few with medicare fraud. To say the bad drs aren't being prosecuted at all is disingenuous
4. Very few drs prescribe meds to people they KNOW are addicts. If you have proof/evidence to the contrary, please provide it
Frustrated and eric...
Thank you both for having an actual calm conversation over a topic. It's very refreshing in the land of internet bravado.
In the end, I am also sick of people trying to get rich off of lawsuits, as frustrated said.
agreed! i can't stand internet bravado...very good term btw
Frustrated, a better analogy for your point #1 would be a liquor store cashier being responsible for a drunk being drunk than a bartender. Unlike the bartender, who watches his customer consume the alcohol and witnesses his behavior, the liquor store cashier just hands over the bottle. What happens from there is out of his hands. Same as with a doctor prescribing narcotics - the drugs are not taken under the doctor's direct supervision. I know bartenders can be held responsible for a customer' intoxication, but I've never heard of a liquor store cashier being held similarly responsible.
Josephus74b So who are these people with legitimate need? If they are in such need why can't the doctor monitor them? Pills are a medical short cut for lazy doctors.
Sandy-2021492 If they are these person's doctor, why don't they know how the medication is being taken? Are you really saying that the doctor should prescribe potent medications and then throw up their hands? If it is a new prescription they should be monitoring them for reactions and if it is an old prescription they should know first hand how the patient is using it. Anything else is poor medicine.
I was addicted to narcotics by my oncologist after cancer surgery. The biggest problem there is that you end up a junkie and after a while it doesn't help the pain. I took myself off narcotics and got my California Compassionate Care Card with my doctor's blessing. When I get the evil eye for smoking pot, I'm quick to point out that my gateway drug was narcotics.
Patients frequently see more than one doctor. Those shopping for narcotics aren't going to be forthcoming with the prescriptions they're getting from other doctors. And, by the definition of first-hand knowledge, the only way the doctor can be sure of how the patient is using the medication is to witness the patient actually taking the drug. Impossible in an outpatient setting.
Josephus: As a physician, I find your post extremely well written and on the money. I have suffered for the last 14 years since being injured on the job while working as a nurse. After 2 failed back surgeries (including a fusion), months spent in a wheelchair, then being rear-ended at a high rate of speed herniating 6 additional discs (3 in the neck, 2 in the upper back, and one above the fusion), I went to my pain management doctor on Thursday, only to spend the next two days going to every pharmacy in 3 counties looking to fill my prescription. The government has gone so overboard because they can't catch the drug dealers, that they have now banned the manufacturers of sending the drug oxycodone to any pharmacy in Florida. Previously they had given the doctors a list of approved diagnoses for which they were able to prescribe this medication, and since that didn't work in the very few months they gave it, they've now stopped it completely at the pharmacy level. I know have to go back to my doctor on Monday to have my doctor switch my medication to something which may or may not work. I'm all for stopping the "pill mills", but my doctor takes insurance, owns his own surgical center where he does interventional procedures like epidural steroid injections and spinal cord stimulator trials. For those of us who are really injured, we're the ones who are being punished. Now I'm going to be changed to a medication which may or may not work. I haven't been able to work for the last 4 years, walk with a walker, and have NO quality of life. I'm sorry for those who have been killed for abusing this drug, but if they hadn't abused it in the first place, they would still be alive. I take my prescriptions exactly as prescribed by the doctors.
@BarbaraB-in Florida, it no longer works to just "change doctors", now that the pharmacy supply is the ultimate problem. It wasn't good enough for them to tell the doctors what they could and couldn't do, now they're stopping the drug manufacturers. If the patient meets the criteria for the medication, why should the government be able to tell anyone that they can't have what works for them? What's next? To do away with all painkillers? If it's not oxycodone, the addicts and dealers will just go on to something else.
@JohnR-you've obviously never suffered from chronic, debilitating pain. As much as I don't want to see anyone hurt, with an attitude like yours, I'd like to see you go through what I have for the last 14 years and not be able to get any pain medicine. Then maybe you'd change your ridiculous thinking.
@Beanathome: what are you doing at home? You're obviously not keeping up with the news. As of January 1st, the state of Florida instituted the computerized pharmacy system so that every pharmacy is required BEFORE filling patients prescriptions to see if they've been "doctor shopping". Obviously this didn't work quickly enough, because by March, they had instituted guidelines for what amount of what narcotic each doctor could prescribe, based on the patient's diagnosis. They stopped the "pill mills" from prescripbing to out of state patients, shut down multiple pill mills, and now have gone to the extreme step of stopping the medication oxycodone from being delivered by the manufacturers to the state of Florida. This is punishing the people who have a legitimate reason for being prescribed the medication.
And for all you people who automatically think that taking narcotics for pain makes you and addict, there's a difference between addiction and dependence. Dependence means that you need the medication and are taking it as prescribed for pain. Addicts take extra pills so that they can get "high". In all my time of being under pain management, I've never taken extra pills, and I've never been "high" from them. They allow me to be able to get out of bed and walk, even if it is with a walker. Before that, I was either lying in bed, or in a wheelchair. I've been through 16 epidural injections, physical therapy, TENS unit, I've had at least 12 MRI's/ 4 CT myelograms/2 discograms and 2 back surgeries. To say that my doctor doesn't have enough proof of my injury to know that I need the medication is ludicrous. My pain management doctor won't even see you if you haven't had an MRI within the last 6 months and you provide pharmacy records showing everything you've been prescribed. I'm now scheduled to have a spinal cord stimulator implanted surgically to try to help with the pain. They don't just do that unless you have a real injury.
These doctors did not make this guy shoot and kill 4 people and then steal 10,000 pills. The only person at fault is Laffer. I know suing will make these families feel better, but this is why our medical costs are outrageous and as stated above, people that do need these types of meds to help with pain are rejected due to the people that have abused them.
I agree with the author 100%. It is long past time for doctors to be held accountable for irresponsible prescribing of pain and anti-anxiety medications. It is clear we have an epidemic problem of abuse in the U.S. I personally have witnessed this in my own family. While I did not sue the doctor responsible I did report him to the Medical Board in my state. After two years of investigation he finally lost his license to prescribe this type of medication. I wish the penalty had been more severe, but was glad for this at least. Without the families of victims taking action abuse and misuse will continue. Obviously most doctors prescribe properly but there are many that don’t. The addicts know all too well who those doctors are. They need to be held accountable.
Doctors are responsible for the choice of med and the dosage, for the first time that they write the scrip. But it's the patient who is responsible for using any med as prescribed, and Laffer didn't do so.
Several years ago, I tripped on a piece of uneven sidewalk and sprained a knee. As he was discharging me, the ER doctor asked if I needed anything for pain. I told him the truth, that I kept ibuprofen at home, and I declined a prescription. But many doctors in similar situations will not hesitate to write heavy-duty pain meds for something that doesn't require anything stronger than what you can buy over the counter. That's the only time that they're responsible for their action, when they write that first scrip.
Most cars are not sold to drunk drivers either but by your logic a car dealer who sells to a drunk that causes a wreck should be punished, maybe the liquor store should be punished too.
The state licensure boards already have the ability to take away the license of a bad doctor if the lawyers will not interfere. There is no need for more laws, just enforce the ones already on the books.
Restaurants are held responsible if they serve too many drinks to someone and an injury occurs.
If you are a DOCTOR it is your responsibility to know your patient. Doctors know full well that addicts are out there trying to get scrips. As a professional it is their responsibility to determine if the patient needs drugs. It is their responsibility not to over prescribe a drug. They are the doctor. The patient is not the doctor. And apparently the Medical Board agreed with me.
Rpearlston: Doctors are responsible when they irresponsibly write the first scrip and when they continue to refill them. Thrust me, it happens way more than you may know.
am,
and how, pray tell, can a dr tell a faker from a true pain sufferer? With the internet, all you need to do nowadays is google some symptoms or look on webmd and you can fake your way through a physical exam pretty well.
ITs easier to sit there and be an armchair judge--if you ever were given the responsibility of taking care of people you would find it a little more difficult than typing on your keyboard....
Why when the CEO's of ANY company isn't at fault for what their company puts on the market!? Time to blam people that are at fault, not everyone else. Doctors are no more at fault for what you an I do than Bill gates is for the computer virus you received for looking at porn for hours on end! Be accountable for yourself and grow up!
Why not correlate the number of doses prescribed with the number of doses manufactured, and penalize the pharmaceutical companies for contributing to the on-going addiction disaster? Tracing doctors who oversubscribe should likewise be held accountable. The feds already monitor how much/many (regulated) pills a doctor prescribes, making a good case for a simple computational algorithm to weed out the bad guys. Or is that too easy?
It's not that it's too easy, but that it's over-simplified. How do you take into account the number of patients fir whom the doctor prescribed these meds, the dosage that was prescribed and the problem for which it was prescribed?
The biggest lie is "one size fits all", and yet, your suggested algorithm would be just that, a one size fits all solution. A rheumatologist, for example, will write more and stronger scrips for pain meds than will a GP. Oncologists and orthopods could also fit into that category. That's just off the top of my head. How do you account for such differences?
@rpearlston, you are absolutely correct. The number of pain med scripts my oncologist writes on a DAILY basis could easily match many GP's combined. However, under a one-size fits all script-distribution plan she would not even be able to cover a fraction of all her patients' pain management needs.
If these doctors were "feeding his addiction," then he would have had a prescription and could have simply purchased the pills. Blaming doctors for the theft of 10,000 unprescribed pills is absurd. Doctors already are regulated concerning prescription of scheduled drugs. Stuff happens. And the fault lies with the bad actor, not the parents, doctors, or any other deep-pocketed scapegoats.
Well said. Let's put the personal responsibility on the person responsible - Laffer. He made a choice to abuse drugs, commit murder and theft. No one had a gun to his head.
That is true! But the whole story is not told here, doctors had prescribed thousands of pills to this guy
and his girlfriend. It was a number of doctors and well over five thousand pills in two years, that is what
lead this guy to go and kill four people and steal 10,000 more pills.
Doctor-shopping is illegal. Again, a bad act by the bad actor. If the individual doctors abided by DEA regs, leave them alone. This guy's poor choices led him to kill and steal. That is what caused this.
Factcheckero: If we just leave the poor doctors alone who over prescribe meds then we will continue to have innocent people killed when addicts go crazy wanting drugs. Stop the source and you will stop the problem. Do nothing and nothing will change.
Define "over-prescribe." I posit that, if they are compliant with DEA regulations, then, by definition, they are not over-prescribing. These medications serve legitimate analgesic purposes. And, as evidenced by the comments below, are becoming increasingly more difficult to obtain by legitimate patients. You cannot blame the liquor store for creating the alcoholic.
The rise in opioid-related crime puts prescribers under greater pressure from law enforcement, leaving many concerned that they will be legally accountable if they fail to identify potential drug abusers who later commit a crime.
Last month Suffolk County Commissioner of Health Services James Tomarken unveiled an initiative to arm prescribers with evidence-based material to serve as a reference and guide when prescribing pain management therapy. The manuscript entitled “Preventing Misuse of Prescription Opioid Drugs” was disseminated to 8,800 doctors, dentists, physician assistants and nurse practitioners who prescribe medication in Suffolk County.
The document provides useful information on non-opioid approaches to managing pain, an Opioid Risk Tool, considerations for dosing and monitoring, suggestions on communicating with patients about pain medications, tips for recognizing signs of prescription drug misuse, and resources for assessment, monitoring and treatment.
The Department of Health Services’ Division of Community Mental Hygiene Services has also made a senior staff member available to prescribers for consultation and referral each business day from 9:00 a.m. to 5:00 p.m.
Prescribers who wish to obtain an electronic copy of the manuscript may contact the Suffolk County Department of Health Services at SuffolkCountyDepartmentofHealth@suffolkcountyny.gov
The so-called Big Pharma companies are every bit as culpable as the doctors - perhaps more so. The point is that the entire way we treat people with illnesses or afflictions of any kind needs revamping - badly. People are way too quick to call the doctor for the slightest ailment. Most of the time the doctors are too quick to write prescriptions. And the more they write, the more Big Pharma earns. It's a very vicious circle all the way around. Change is pathetically overdue. Will it ever happen? Not likely, not when too many people are making way too much money.
My husband is abusing his pain pills. I hate him for it and I hate his doctors that does NOTHING to stop him. I have complained to his doctor several times but my husband still walks out with pills. My husband is responsible for his actions however, having a doctor not listen to the fact that my husband is abusing the pills does not help. My husband cannot live without them now and will probably die because of them. There is no accountability for how much he takes and the doctor does not do pill counts nor does he prescribe other non-habit forming drugs.
I hold both responsible...
Is there not further steps you can take? Obviously his doctor and your husband are not changing the situation. Can you not contact someone in your community to look into this, get him other kind of help/therapy, something???
LORENA325303, I was addicted to precription pain meds for years, at one point taking almost 150+ pills a day, so I can obviously relate to what your husband is going through. I can also relate to your feelings of helplessness because my ex-wife felt the same way. The only difference is that she didn't try and talk to my doctor, she had just hoped that one day I would stop on my own. My advice to you is, if you haven't been able to explain the situation to your husband's doctor and are adamant about helping him, rather than punishing him for the hurt he has caused you through his drug abuse, I would contact the DEA, they are responsible for issuing a doctor's DEA number that allows a doctor to prescribe narcotics, and they will investigate any doctor who they feel is over prescribing narcotics. Before actually making that call to the DEA I would tell your husband's doctor what you are planning to do and hopefully that may be enough to make him think again about what he's doing. You will need to prepare yourself for your husbands anger once he finds out how far you've gone to get him the help that he needs. Initially he won't see you as trying to help him, but as the one responsible for stopping his pill supply. It would be wise to consider having a family member there as support if you decide to explain to him before hand what you want to do. I can almost guarantee you that he will thank you later once he realizes that what you've done was because of the love you have for him and your need to keep him from slowly killing himself by continuing to abuse the pills. I wish that I would have had someone like yourself who would have stepped in earlier. Good Luck
This would be like telling waitresses they can no longer give out food, telling mechanics they can no longer work on cars. Doctors give drugs, period. If you walk in a doctors office you will get a drug. He/she will usually spend at least two minutes getting your symptoms so he/she can run a checklist of which drugs the pharmaceutical rep left or which drug is sponsored by the company that gives the best free stuff away but you will get a drug whether you actually need it or not.
Your opinion would hold more weight if you actually did some research. Drug reps are not allowed to give "free stuff." They bring lunch.
No way. It's already way to hard to get the stuff if you're actually in pain. Most of the time doctors will look at you like you're some kind of junky and tell you to take a Tylenol.
Drugs don't kill people.
People kill people.
Don't blame the "doctors" put the blame where it rightfully belongs on the DEA . It's the DEA that allows the drug manufacturers free reign when it comes to regulating opid production and distribution . The DEA says it has no problem with drug manufacturers who are starting to produce a new pure form of hydrocodone that is 100 times more powerful than what is currently on the market . The DEA says drug manufacturers can regulate themselves .
The United States consumes 80% of the global production of opids/pain killers .
The DEA allows the dumping of these addictive poisons in our country which kill tens of thousands of people every year and addicts millions and yet it prosecutes a war on cannabis which addicts or kills no one .
The Joint Commission (JCAHO) has stressed pain management over the last several years, requiring that every patient be asked if they are having pain and rating the level. Although this is an admirable goal, I don't wonder that it has backfired in the concern of losing accreditation.
Thanks for sharing the information. That’s a awesome article you posted. I found the post very useful as well as interesting. I will come back to read some more.
South Florida is full of pain clinics that have a doctor at a desk who writes up to 100 prescriptions a day.
Most of the patients come from west Virginia, Kentucky, fill there scrips then head home with that hillbilly heroin to resell at twice the price back home. Republican job creation by Jeb Bush governor of Florida2003
@Jake-you need to recheck your facts. There was recently a law passed that no doctors can prescribe narcotics to an out of state patient. It used to be a fact, but is no longer allowed.
People addicted to perscription pain meds will Dr shop. Pill mills run buy unscruplus Mds are a real issue. I have had a debilitating back injury and needed real pain management and that proved very difficult, After surgery I was off all but OTC meda 7 days after surgery.
Trying to use a little restraint, Caplan has framed a social (not a "doctors") problem well and followed it with a nonsensical conclusion.
" If we can all spend so much time and energy worrying about and hoping for justice for the Conrad Murrays of the world, shouldn’t we create a public policy and legal doctrine that hold accountable those doctors who prescribe these potent painkillers indiscriminately?"
I guess he is assuming we don't have a public policy and legal doctrine that holds accountable those doctors who prescribe these potent painkillers indiscriminately!
Duh! That is why Conrad Murray was on trial.
Slow day in ethics I guess.
You folks need to take your advice and put it where the sun don't shine. Any of you doctors? You folks create misery for chronic pain patients. In other words, mind your own business.
I'm guessing you enjoy your pain meds-and don't want to lose them.
Nothing wrong with him enjoying not being in constant never ending stomach turning chronic agony.
To BarbarB
What a jerk comment.
I suffer from Migraines and other headaches chronically, for over two decades now. I follow several regimens that have nothing to do with drugs - diet, exercise, sleep patterns, etc., and this has helped. But, I still get them frequently (not every single day like before, but frequently). As far as drug choices, I first go to Excedrin. If that doesn't work, I go to a Hydrocodone (5mg narcotic), if that doesn't work, I go to Sumatriptin (Imitrex, non-narcotic). The Imitrex will usually do the trick, but it isn't recommended for frequent use, and is siginificantly more dangerous than a narcotic - stroke and heart attack risk.
This regimen was developed using trial and error over several years with different meds (butalbital, anti-anxietiy .....). We finally found a regimen that works - I don't live in continual fear of the headaches, and have a normal life with no work interruptions from the pain. I go through 30 pills of 5mg hydrocodone (the smallest amount) about every 3.5 to 4 months. This is between ONE hydrocodone pill every 3 to 4 days. This level has not changed, either up or down, in over 15 years.
I am sure that should the changes recommended in this article take affect, I can say bye-bye to a normal life (along with God knows how many others). It's too bad that some people (patients and doctors) abuse the system. STOP HURTING INNOCENT PEOPLE WHO NEED THESE MEDICATIONS, JUST TO STOP THE ABUSERS. THAT IS WHAT WILL HAPPEN.
You know what a migraine headache looks like on an MRI?
Answer: normal anatomy. You want to know what the definitive test for
diagnosing migraine headaches is. Answer: there is none. You want to know how painful
they can be. Answer: ask someone like TuraNarEl; they are excruciating. Can
someone look up the signs and symptoms of a migraine on Wikipedia and do a
great job of fooling someone into thinking they have this disease? You bet!
Honestly do doctors now have to be grand inquisitors and put
every patient through excessive and needless trials and tribulations prior to giving
them pain killers? According to this article and many posters, the answer is
yes. I’m not advocating the overuse of narcotics and I do agree that we should
strive to eliminate prescription drug abuse. However, it is a fact of life that
by adequately treating many patients that truly do have pain, there will be
some that “beat the system.” By imposing more and more lawsuits and
restrictions on prescribing narcotics, far more patients who are truly in pain
will be undertreated than will drug seeking patients be stopped. If our country
keeps piling on restrictions and lowering the threshold for law suits, doctors
won’t be able to practice medicine at all… they will be spending their entire career
covering their @ss (now it’s about half medicine and half CYA)
@ BarbaraB-your comment to jstsyn was ignorant and totally uncalled for. Don't you think that those of us with chronic pain would much rather be able to have some kind of life than to depend on a pill to be able to get out of bed everyday? I lost a job I loved (Assistant Nurse Manager of an Emergency Department), had my beautiful house foreclosed, and have spent the last 4 years trying to get approved for disability, which was finally approved. I'd love to never have to take another pill if I could have it all back. By the way, I was injured on the job taking care of sick people. In your opinion, all people who have to take narcotics are drug addicts. I hope you never get injured-I went from making $50,000+ a year to making zero. I walk with a walker and the only time I go out is to the doctor's appointments due to amount of pain I have (and I have all the tests to prove my injury). If you don't know what you're talking about, you have no right to judge someone else.
As I said in an earlier post, I was addicted to prescription pain medication for years. It started from a sports injury I suffered and after going to the doctor I was given a prescription for a commonly prescribed narcotic. The injury took a long time to heal and I was given numerous precriptions for the narcotic. Long after the injury healed I found myself addicted and taking a lot more of the pills than were prescribed. Because of my tolerance increasing I was taking 150+ pills day. In order to accumulate that many pills I had to doctor shop. I became good at faking back injuries which are one of the hardest for a doctor to pinpoint what was causing the pain. This all happened back in the late 70's and early 80's and doctors back then weren't nearly as suspicious as they are today and it wasn't difficult obtaining a pain med prescription. Today with the rapid rise of addiction in this country doctors have become wary of patients asking for pain meds, and they should be wary. There are still a lot of doctors out there who are more interested in money than embracing their Hippocratic oath which just fuels the addiction problem. But to hold a doctor responsible for someone's crime because of the person's addiction is crazy. The incident that happened is unfortunate, but the blame is solely Laffer's and not the doctor's. It has become extremely difficult for doctors to separate those who actually need pain relief from those who are addicted, and who really suffers in the end are the ones who are seeking relief from crippling pain. Who wants to be the one to tell someone that the reason they won't be given any relief from their pain is because the doctor is unsure if they really need it or are just trying to pull a scam? Regardless of the obstacles put in place to deter abuse, there will always be someone who will find a way around them. In this situation, if Laffer hadn't gone in and shot those people, but waited until after the store closed and broke in and got his 10,000 pills he would have been guilty of burglary and not murder, would everyone want to hold the doctor responsible for that also? It's a difficult situation without an easy answer.
Doctors should absolutely be held responsible for the abuse.
As a chronic Migraine sufferer, and one that also has PTSD and is aware of her addictive personality, I take extreme offense at the idea. I know I'm prone to addiction, I also know I have a CHOICE. My doctor knows I can control the impulse to overdo. We all have a choice. Punishing the healers, for listening to those in pain would be a travesty. Who is to decide whose pain is important? It's all relative. I managed to quit smoking, which is harder than I imagined after three tries after 53 yrs. I know I will have no problem. We all have a choice. Blaming the doctors makes no sense, and could lead to MORE illegal drug traffic.
Addiction is not a choice.
Yes, actually it is. You can CHOOSE not to have that first drink, after being on the wagon, or stay sober. I choose NOT to give in to the temptation to have another cigarette. I choose NOT to allow myself to become dependant on pain meds and use them only as necessary. MJ chose to overdo the "milk". Addicts choose every day. Addiction is in a way a crutch for the weak willed.
Art should spend about 2 weeks doubled over in pain then lets hear his 'opinion'. What a jerk!
It amazes me that some people don't understand what chronic pain is. Come spend one day with me and you will learn what it does to me. I see a pain management doctor. I had to sign a med-contract with him in order to get my pain meds. He gives them to me monthly and only so many a month. In the state of Kansas, there system is set up that you cannot go doctor shopping. I almost lost my pain meds last year even though I had informed the pain management doctor that I was having surgery and that the surgeon was going to supply my meds during that time. So I stopped the pain management doctors med and used the orthopedic doctors medication....which by the way was a different med. Be responsible with your meds. Don't share or sell them. And mostly, don't mess with my meds to keep me almost pain free.
I'm really sorry about those who find themselves in the grip of addiction. But please don't speak for all of us who take pain medications so we can live as close to a normal life as possible without having to think about our constant pain all day long. It's sad there are folks whose weakness allows them to succumb to the lure these drugs create. Nonetheless, there are many (I would venture to say the majority) pain patients who take their medicine as prescribed and don't ask for or seek increased dosage, nor do we go "doctor shopping" for more prescriptions. Nonetheless, we're treated like criminals because we need these drugs to help us live normally. I resent the fact that I have to submit to urinalysis, like an inmate, every time I visit my doctor for a prescription refill, when I'm doing what I'm supposed to do with my medications. It's degrading and borders on being an unconstitutional invasion of my right to privacy. I'll employ an old adage normally used with guns to this; If doctors are responsible for patients' irresponsible behavior, then pencils, pens, and keyboards are responsible for misspelled words.
Most doctors are not responsible for the inappropriate and illegal behavior of their patients. Just as a parole officer can't live with her clients 24/7 and regulate their behavior, neither can doctors regulate their patients' behaviors. It's irresponsible, illogical, and just plain stupid to hold doctors responsible for the behavior of their patients. Criminalizing doctors and legitimate pain patients IS NOT going to fix this problem or help this situation. Perhaps law enforcement should stop asking physicians to do their job for them, and stop treating me like I'm guilty before proven innocent. If they are going to force doctors to be responsible, then it is incumbent upon the government (though I hate to say this because I'm not sure I trust government to do this properly) to create and implement a national database doctors and pharmacists can use to ensure the bad behavior is detected and dealt with, and allow the doctors and legitimate patients to go on with their lives unmolested by unfair treatment.