Earlier in the summer, President Donald Trump declared a national state of emergency regarding the opioid crisis in the United States. The broad class of drugs known as opioids function by acting on the body's opioid receptors to reduce the sensation of pain. In small doses as prescribed by a doctor, opioids are effective for pain relief when NSAIDs like ibuprofen are not strong enough. However, the substances are extremely addictive, and users can quickly develop a chemical dependency on them if their use is not strictly monitored.
The US Government has taken a vested interest in prosecuting doctors and pain management clinics that have been termed "pill mills," meaning that they fail to adhere to the best practices for prescribing opioids. In his smash hit book American Pain, author John Temple documented the dramatic rise and fall of a chain of pill mills in Florida especially and how two friends convinced licensed doctors to use their credentials to purchase and prescribe opioids to patients without subjecting them to physical examinations or studying their medical histories. Today, both the founders of the pain clinic and many of the doctors they employed and exploited have pleaded or been found guilty of federal crimes related to illegal distribution of controlled substances.
Pharmacy law experts have also begun to assign pharmacists some responsibility for the amount of opioids that hit the street. In 2015, a California doctor was sentenced to 30 years in prison after being convicted of second-degree murder for the deaths of three patients following an opioid overdose. Doctors are indeed permitted to prescribe and dispense of controlled substances, but only in the most extreme circumstances determined by a thorough physical examination and interview with the patient. Since the DEA issued its guidelines for the dispensing of controlled substances in the 1970s, desperate dealers and addicts have looked for ways around the laws.
At present, pharmacists' and doctors' responsibilities regarding who truly needs opioids is a very gray legal area, but the medical community is increasing its internal pressure for doctors and pharmacists to behave with the utmost integrity. Medical professionals know of the "red flags" for when they most certainly should not dispense of opioids. For example, the laws governing the amount of opiates a person can have at once vary state by state, with some states setting stricter laws and others keeping them less intense. As such, doctors are cautioned against prescribing drugs to lots of out-of-state patients. The West Virginia Supreme Court ruled that no matter their past (perhaps illegal) behavior, substance abusers have the right to sue the prescribing doctor, who then bears the burden of proof to demonstrate that the prescription was warranted by the consultation and patient needs.
Nowadays, medical boards and boards of pharmacy are much quicker on the trigger to launch investigations into questionable prescribing practices and hire third-party auditors to ensure that pharmacies continue to abide by the law. In order to get a handle on the opioid crisis, everyone needs to extend their vigilance and hold their colleagues to the highest standards.
