While Americans continue to die from drug overdoses increasing rate, policymakers are seeking interventions to reduce reckless medical practices that put patients at risk of addiction. Many of these proposed laws look for limit the extent to which patients can obtain prescription opioids from their doctors. But like ours new studypublished this week in Yale Law & Policy Review Inter Aliaclaims, prescription opioids are not to blame for today’s crisis.
Laws that arbitrarily set duration or amount restrictions on opioid treatment regimens are based on the belief that increased access to prescription opioids has led to an increase in addiction and, ultimately, overdose deaths.
However, while opioid deaths continue to rise, opioid prescription rates are rising reduced every year since 2012. Furthermore, nonmedical use of prescription opioids has remained relatively stable stable over the past two decades. As we point out in our study, popularized spike in reported rates of nonmedical opioid use between 1998 and 2002 is most likely caused by major changes in research methodology. And if there has been an actual increase in the non-medical use of opioids, it would be because of codeine, rather than overprescribing common painkillers like OxyContin. The claim that the introduction of OxyContin in 1996 “boosted” prescription opioid use is simply not supported by the data.
However, such claims about Purdue Pharma were echoed during last week’s House Energy and Commerce hearing hearing on the fight against fentanyl overdose. Tail. Tony Cárdenas (D–California) foreword his examination with “Purdue, the Sackler family and crime wages—still one of the wealthiest families in the world…that was a big part of where we are today.” Rep. Mariannette Miller-Meeks (R–Iowa) shared a similar sentiment sentiment: “As we know, a lot of opiate addiction started through post-operative care and pain management, pain relief.”
But illicit opioids like heroin and fentanyl, not prescription painkillers, primarily the culprit behind today’s opioid crisis. By reducing access to legal prescription channels, laws restricting the use of prescription opioids only increase the likelihood that a pain patient will have to turn to the black market to satisfy their opioid demand with dangerous illicit drugs.
Yet academics and policymakers continue to pursue reforms that would only exacerbate the issue. For example, Loyola Marymount University Law Professor Rebecca Delfino proposed for Congress to pass the Prescription Abuse and Prevention Act (PAPA), legislation that would make it easier to prosecute doctors for violations Controlled Substances Act (CSA). No legislation citing the PAPA has yet been introduced, but policymakers have shown appetite criminalize doctors for prescribing opioids in the past.
According to the CSA i regulations according to it, it is illegal for a doctor to “knowingly or intentionally” prescribe a controlled substance unless the prescription is “for a legitimate medical purpose…in the ordinary course of his professional practice.” Like CSA, PAPA offers intent or knowledge a man’s thing standard, but also allows a “presumption of knowledge” to be established by “the physician’s expert knowledge, practice experience, and specialized medical education.”
Simply put, if a patient overdoses on a drug prescribed by a doctor, the event alone may be sufficient to convict the prescriber of second degree murder. This is because the medical expertise should have prevented the patient from being in such a vulnerable situation.
While prosecutors should not be expected to go after every physician whose patient overdoses under PAPA, the fact that such an event would likely result in an automatic conviction upon indictment would worry many physicians. What’s more, PAPA could give prosecutors the arbitrary power to jail any doctor whose patient overdosed while under their care. Such potential liability would lead to further reductions in prescribing across the country, which would only increase deaths from illicit opioids.
Last mandate, Supreme Court clarified in Rouen v. United States to be liable under the CSA, a physician must “knowingly or intentionally act in an unauthorized manner” and not merely intend or know to prescribe a controlled substance. Although the CSA regime is not perfect, the ruling u Rouen provided much-needed clarity to the standard of liability under the CSA and protected physicians from facing criminal prosecution simply for performing their work as authorized.
Criminalizing doctors is not the way to end the opioid crisis. As much of the literature shows, opioid prescriptions rarely lead to addiction even in treatment acute or chronic pain. With more than 88 percent of opioid overdose deaths now involving either heroin or fentanyl, targeting prescriptions is not an effective way to address the mortality problem. The way forward is to expand access for addiction and pain patients, so that those who most need a safe environment to consume opioids can do so legally.