Doctors in the dock as US tackles national opioid crisis
In the United States, opioid addiction has become a national health emergency. Now the doctors accused of over-prescribing the dangerous painkillers are being brought to justice. FRANCE 24 takes a closer look.
“You are, in my opinion, the worst sort of drug dealer,” West Virginia federal court Judge Irene C. Berger told a defendant at his sentencing hearing on Wednesday. “You poured thousands of prescription opiates into the streets, to people you knew weren’t taking them as prescribed.”
Dr. Michael Kostenko was handed a 20-year sentence for prescribing oxycodone to patients whose health issues did not warrant the powerful painkiller, derived from opium and known to create strong physical and psychological addiction. The prescriptions led to the overdose deaths of two of his patients.
Kostenko’s case is emblematic of a crisis that has wreaked havoc in the US for years. Drug overdoses are the leading cause of death among Americans under 50 today, according to the New York Times. In 2015, the number of deaths from opiates and heroin surpassed a record 33,000, according to the Centers for Disease Control and Prevention (CDC), which says this figure has quadrupled since 1999.
To convey the full measure of the devastation, a panel of experts offered a compelling comparison: It noted that opiates and heroin reap the equivalent of one September 11, 2001, terrorist attack every three weeks in the United States. The analogy apparently struck a nerve with authorities: On August 10, US President Donald Trump said he planned to declare the opioid crisis a national emergency.
Overwhelmed by funerals
West Virginia, where Kostenko practised, registered the highest overdose death rates in the country in 2015 (41.5 per 100,000). The scourge is such that authorities are struggling to keep up with the funerals – deaths in the state overwhelmed a programme set up to assist needy families with burial costs.
In videos posted on YouTube, Kostenko, who at the time headed the thriving Coal Country Clinic, demonstrated his unorthodox methods. In a group setting, he showed patients how to cure their aches and illnesses with changes in diet and behaviour, CBS News reported. Afterwards, each patient filled out a medical form, paid $120 in cash and walked off with oxycodone prescriptions – obtained without undergoing a private consultation.
The doctor even wrote prescriptions for patients he had not seen. In 2013, in the space of a single day, 375 prescriptions were written up for 271 patients, an allocation of more than 19,000 oxycodone pills – and representing $20,000 in revenue for the clinic. Between January 2011 and March 2016, 16 of Kostenko’s patients died of overdoses, according to the Charleston Gazette-Mail, a local newspaper.
The doctor’s attorney, Derrick Lefler, sidestepped the question when FRANCE 24 asked whether Kostenko had expressed remorse, saying only that his client was disappointed by the decision and noting he had been handed the maximum penalty.
That maximum sentence highlights the American justice system’s firm new resolve. In early August, Attorney General Jeff Sessions announced that US prosecutors would target unscrupulous doctors and pharmacists in order to fight the “epidemic”.
In June, a family doctor practising in New York’s affluent Upper East Side was taken into custody, suspected of having prescribed more than 2 million oxycodone pills between 2012 and 2017 in exchange for cash from patients whose medical conditions did not warrant the drug, the New York Post reported. On August 22, a pharmacist from the town of Medford, New Jersey, was found guilty of running an opiates business, a so-called “pill mill”, out of his two pharmacies. He faces up to 20 years in prison on each of the five counts against him.
As these news stories multiply, public mistrust in the medical profession is growing. A 2016 survey showed one in three Americans blame doctors for the opioid epidemic – about as many as those who blame the individuals abusing the drugs. Indeed, prescriptions for the dangerous painkillers have quadrupled between 1999 and 2014, the CDC says.
According to the National Institute on Drug Abuse (NIDA), 86 percent of heroin users initially tried opiates. Those who become addicted also turn to synthetic substances like Fentanyl, which is 80 times more potent than morphine, NIDA says.
The American Medical Association, the West Virginia State Medical Association and the Federation of State Medical Boards did not respond to requests for comment. But some doctors are speaking out, like Dr. Sudip Bose, an emergency physician and Huffington Post contributor.
“It once was commonplace to prescribe a bottle of Vicodin for a sprained ankle,” Bose wrote in an article on the site. “When I was a training resident, I thought my colleagues and I were doing the right thing. Patients were happy when they got tablets of Vicodin for the ankle sprain. We were happy and felt compassionate. The regulatory bodies were happy because we were addressing pain … Pharmaceutical companies were happy and kept advertising to us.”
He continued: “It was a win-win for all unless or until that patient came back asking for a prescription refill. After 30 days on a sprained ankle, you know it’s not the pain they’re looking to alleviate, you know they’ve become addicted to the opioid you initially prescribed to help manage the pain.”
Bose takes issue with a 2001 rule according to which doctors must take into account a patient’s pain levels during a consultation, treating it as a “fifth vital sign” in addition to body temperature, blood pressure, heart rate and breathing rate – advice he suggests contributes to the over-prescription of painkillers. Bose cites a group known as the Physicians for Responsible Opioid Prescribing, which wants the rule re-examined and which argues: “Pain is a symptom, not a vital sign."
Treatment for addicts does exist. Bose discusses medications that, for example, prevent a prescribed drug’s pleasurable effects on the brain to help people shed their addictions. He advises the public to “trust your doctor, who’s going to prescribe the right treatment and give you the right medicine, for the right situation at the right time”.
This article was translated from the original in French.