Thursday June 29th 2017

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Opioid Prescription Laws: How One “Guilty” Verdict Could Change Everything

Landmark Guilty Verdict will likely Impact the Future of Opioid Prescriptions

As the death toll from opiate overdoses continues to rise in our country, physicians are writing fewer opioid prescriptions for patients suffering with chronic pain. There are a multitude of reasons for this downturn, but one of the major reasons is physicians do not want to be held accountable for their patient’s accidental death by overdose.

On October 30, 2015, a California physician was convicted of three counts of second degree murder for prescribing excessive doses of controlled substances with no legitimate medical necessity. This court decision has impacted the mindset of practitioners and will likely influence more restrictive prescribing of opioids in the foreseeable future.

A look into how doctors can change their prescribing practices and recommendations from former DEA Special Agent, Warren Rivera. More here, with a section at the end for your questions or comments.

The Guilty Verdict on Irresponsible Rx Practices

On October 30, 2015, California physician Hsiu-Ying “Lisa” Tseng was convicted on 23 counts, including 3 counts of 2nd Degree Murder, 19 counts of issuing unlawful controlled substance prescriptions and one count of obtaining a controlled substance by fraud. The guilty verdict marks the first time in the United States when a doctor was convicted of murder for over-prescribing drugs.

On February 5, 2016, Tseng was sentenced to 30 years to life by a California Superior Court Judge.

The Prescribing Practices in Question

The irresponsible prescribing practices of the convicted physician were allegedly for financial gain with no regard for the safety of her patients. Court records showed her medical practice, co-owned and operated with her physician spouse, had been waving a few red flags over the years.

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  1. The practice grossed more than 5 million dollars over a three year period.
  2. The prosecution was also able to prove that Tseng fabricated medical records in an attempt to cover-up improper prescribing.
  3. It was also proven that Tseng did not change her prescribing practices even after receiving calls from law enforcement or concerned family members informing her that her patients had overdosed or were addicted.

This landmark verdict has compelled doctors to re-think how they are prescribing opioid pain pill medications. Along with the CDC’s (Centers for Disease Control and Prevention) Guidelines for Prescribing Opioids for Chronic Pain and the increased number of deaths due to opiate overdoses…the guilty verdict is persuading physicians to utilize other forms of therapy besides opioids for chronic pain.

But is this benefiting everyone?
No.

Physicians who abide by the CDC’s guidelines are infuriating chronic pain patients who have received opioid therapy for years, but are now unable to obtain opioid prescriptions. Some long-term users of legitimately prescribed opioids claim it is the only therapeutic solution for them to live a productive pain-free lifestyle. Chronic pain patients who are refused opioids are sometimes turning to another form of self-medication by taking street drugs like heroin or even worse, fentanyl. Other patients who are no longer able to legally obtain their pain medications become depressed and even suicidal.

What are Responsible Prescribing Practices?

As a former DEA (Drug Enforcement Administration) agent, I provide consultation to physicians on best prescribing practices from a DEA regulatory standpoint. I advise physicians on how to remain DEA-Compliant when prescribing controlled substances. What are some of the main tenants that I support?

  1. Physicians should take whatever steps they believe are medically necessary to benefit the patient, including prescribing opioids, as long as there are no signs of abuse or diversion.
  2. If the physician continues to prescribe opioids for chronic pain, they should document in the patient chart how the benefits of opioid prescriptions outweigh the risks.
  3. The prescriber should also explain the dangers and risks associated with opioid therapy and document that verbal warnings were given to the patient in the patient’s chart.
  4. Patients who exhibit aberrant drug related behavior or test positive for illicit substances should not receive additional prescriptions for controlled substances. Instead, the patient should be referred to a drug addiction treatment center and the physician’s actions should be outlined in the patient’s chart.

One of the “red flags” that aided in the prosecution of Tseng was that she did not change her prescribing practices after receiving several calls from law enforcement and concerned family members. Physicians should not ignore these types of warning signs from outside sources and should take appropriate action when this does occur.

Professional Consultation Can Help

Practitioners who desire to have their practice audited for DEA compliance relative to prescribing controlled substances, or if anyone would like to receive training on the diversion of pharmaceutically controlled substances from retired DEA Special Agent Drug Diversion Expert Warren Rivera, please visit www.trainingidea.com or https://www.linkedin.com/in/warren-rivera-aa4a3221

 

Reference Sources: DEA: Doctor Convicted of Three Murders in Prescription Drug Overdose Case
CDC: Guideline for Prescribing Opioids for Chronic Pain 
L.A. Times: Doctor convicted of murder for patients’ drug overdoses gets 30 years to life in prison 
Pain News Network: Are CDC Opioid Guidelines Causing More Suicides?
WBUR: 91 Percent Of People Who Overdose On Opioids Are Able To Get Another Prescription

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About Warren Rivera

Warren Rivera is a retired Assistant Special Agent in Charge from the U.S. Drug Enforcement Administration. Mr. Rivera is an experienced public speaker, trainer and an expert in the diversion of pharmaceutical controlled substances. Mr. Rivera currently owns Training Idea, LLC, a private consulting firm that provides training on DEA matters to the healthcare industry, law enforcement and the community.

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