The opioid crisis is a complex and confounding problem trailing social, psychological, legal and medical entanglements. In treating it, doctors, lawyers and politicians must hew to the ancient maxim: First, do no harm.
Something went awry in recent communications between government leaders and the medical community, creating confusion and worry among some physicians that appropriately caring for patients in severe pain could result in criminal charges. It’s not true, those government leaders say, but somehow, it was the message received. For the sake of people suffering pain that may be unbearable, those leaders need to ensure the point is clear.
The confusion began with comments by Erie County Executive Mark C. Poloncarz and Acting U.S. Attorney James P. Kennedy Jr. about plans to hold doctors accountable for their roles in opiate-related deaths. What doctors heard – and what, frankly, didn’t make sense – was that if someone died of an opioid-related cause and that if that person had been prescribed an opioid by a physician, the doctor could be charged with a crime.
To doctors, that sounded like a warning to shun patients in severe pain. The patient could become addicted, turn to heroin and die of an overdose. It’s happening with frightening regularity in Western New York and around the country. Alarmed, leaders of the medical community warned that doctors would stop treating patients in pain to avoid the risk.
But Poloncarz and Kennedy say they believe doctors misunderstood their intentions, which, they said, represent no change from the past. When doctors commit actual crimes, such as dispensing opioids without medical cause, they risk criminal prosecution. That’s appropriate, as the medical leaders readily agreed.
But however the confusion arose, it is incumbent on Poloncarz and Kennedy to clear it up. The rate of opioid addiction counts as an emergency; dealing with it requires a clear understanding of the issues.
Doctors, too, need to be sure they have learned the lessons of the past several years. They say they thought, based on false information from the pharmaceutical companies, that the drugs were safe, and prescribed them more freely than they would have otherwise.
The question of the companies’ liability is real. Several governments, including Erie County, have sued manufacturers of opioid painkillers, alleging that they concealed information about the addictiveness of the drugs.
But whatever the facts were, the truth is known now. Many people using opioids prescribed for them have become addicted, turning to street-corner heroin – chemically similar and much cheaper, though often spiked with lethal doses of fentanyl – once their prescriptions expire.
Some patients are in chronic and excruciating pain and desperately need the relief that these drugs can provide. Doctors need to know how to manage those patients and what their role should be for those who become addicted.
What can’t happen is for doctors to turn away those patients based on a false belief of their own exposure to criminal sanctions. The problem is difficult enough without making it worse.