When Prosecution Replaces Prescription

By Lynn Webster MD

Chances are that most of us know someone with disabling chronic pain. Spotting these people is not very easy. If she is in pain, for instance, you can bet she won’t share it with anyone. The stigma associated with chronic pain often produces a sense of shame and, therefore, desire for concealment.

Imagine this same scenario but on a national scale, with the only difference being that instead of some people withholding problems, society is withholding the solutions.

Such is the plight of Americans who suffer from some type of chronic, persistent pain—a group of people that the Institute of Medicine estimates to number more than 100 million. Many of these people find relief with nonopioid treatment, but there are countless others whose pain is so severe that opioid therapy is the only option that provides enough relief for them to live functional lives. Because of this, it is critical for opioids to remain an available option to those who suffer agonizing pain. It also means that we must take the necessary steps to ensure that these medications are not abused or inappropriately prescribed.

Today, in the United States, prescription drug abuse and opioid-related deaths are a full-fledged epidemic. Drug overdoses have tripled since 1990, and prescription drugs are a driving factor. More than 12 million people reported using prescription painkillers (i.e., opioids) without consent of a prescribing physician in 2010, and opioid-related emergency room visits have skyrocketed in recent years.

To combat these tragic realities, the federal government has moved aggressively to regulate, restrict and monitor the use of painkillers. Even so, the prescription drug abuse and overdose epidemic persists. Now, in the face of increasing pressure to do more, we’ve turned to a new tactic: the prosecution of doctors who treat patients using painkillers.

Quite recently, a pain physician in Des Moines, Iowa, was accused of involuntary manslaughter and nine counts of criminal wrongdoing. The physician, Daniel Baldi, DO, thankfully, was cleared of any wrongdoing by the judge and jury. Far from proving the prosecution’s assertion that reckless prescribing led inevitably to the deaths, testimony revealed that the decedents died from a variety of causes, including deteriorating medical conditions, the use of medications not prescribed by Dr. Baldi and the abuse of illicit substances. Tragically, Dr. Baldi is professionally scarred and financially ruined, and the legal system offers no recourse for this gross prosecutorial overreach.

When a physician stands trial for criminal charges for essentially practicing medicine, patients pay the ultimate price, through inevitable abandonment by the medical establishment. Fearing reprisals, practitioners reduce their willingness to prescribe strong medications, even when they are critical to recovery and administered in a safe manner. In short, patients are denied the care that they need. Oftentimes, these patients resort to a hopeless and dehumanizing search for medical professionals who are willing to help them. They find themselves set adrift in a health care system that does not reimburse appropriately for safer alternatives and evidence-based therapies. In desperation, patients turn to clinicians whose medical training lacks even the most basic instruction on managing pain.

Former colleagues and I also have dealt personally with the tragedy of patients who died, not as a result of treatment but in spite of it, at a pain clinic in Salt Lake City. We all felt great torment throughout our practice when forced to choose between treating patients in excruciating pain and becoming a target for prosecution, especially in treatment plans involving opioids. That dilemma is only worsened when one realizes how close the link is between chronic pain and suicide. The scientific literature tells us that patients with chronic pain are two to three times more likely to take their own lives.

Opioid medications are not the only therapy, nor are they always the best therapy for patients in varying degrees of pain. They clearly bring risk and should be reserved for a subset of the patient population who truly need them. Then—and only then—should opioids be prescribed by clinicians with the training and competence to assess and monitor patients in accordance with accepted medical guidelines. Moreover, each and every patient with chronic pain should have access to a minimum level of insurance benefits, and for some patients with certain pain conditions, that may include opioids.

Over the long term, while we work toward finding better, nonopioid therapies, we need to change our attitudes about chronic pain in America. More people than we realize live with chronic pain every day. When I practiced medicine, I heard the cry for help from patients too often, many of whom just wanted someone to believe that their pain was real. Hopefully, society soon will start to believe that we need a better way before the chronic pain and drug overdose epidemic claims one more life.

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Lynn Webster is the immediate past president of the American Academy of Pain Medicine based in Chicago, Illinois. He lives in Salt Lake City, Utah.

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