A Recent Supreme Court Ruling Will Help People In Pain

The Supreme Court's ruling on prescription drugs was welcomed by the medical community. The court ruled in favor of several doctors who were convicted of acting as drug dealers by overprescribing pain medication.

The decision requires prosecutors to prove criminal intent, rather than just having to show that their prescriber did not conform to standard guidelines, in order to win the case against them.

The decision to make the law clearer may give people with pain or addiction better odds of receiving appropriate medical care.

In the face of a decades-long overdose crisis that continues to escalate, doctors fear that they will be thrown in prison for drug dealing if authorities decide that their practice is out of line. Hundreds of doctors have been prosecuted, and thousands more simply stopped writing prescriptions because they thought the benefits would be better.

Justice Samuel Alito wrote in his opinion that a doctor who makes negligent or reckless mistakes in giving drugs is still acting as a doctor. The same cannot be said when a doctor issues a prescription to facilitate addiction.

The remedy for bad doctoring is civil malpractice law and not criminal prosecution.

The question of whether the government should have to prove that accused doctors crossed the line from medicine into drug dealing was debated by the lower courts.

In the case of Dr. Ruan, prosecutors alleged that he began to prescribe large amounts of a particular brand of Fentanyl after investing a large amount of money in the company that made it. The court took his case because his lawyers argued that the jury instructions did not allow him to properly defend himself, despite the fact that he was a drug dealer. The Court sent his conviction back to the appellate level so that the lower court could decide if he should have a new trial.

Federal law doesn't say if a prescription is legal if it's written for a legitimate medical purpose by an individual doctor. It doesn't say what a legitimate medical purpose is.

When the Centers for Disease Control and Prevention published their guidelines for prescribers of opiate drugs, they were adopted as hard mandates. Afraid that standing out would paint a target on their backs, doctors have reduced or eliminated opioid doses used for chronic pain to conform to the guidelines.

Thousands of people are suffering unnecessarily. Before pharmaceutical marketing drove a huge increase, prescribing rates were below those of the mid 1990s. The number of prescriptions for narcotics for cancer patients who were explicitly exempt from the CDC guidelines fell 21 percent over the course of three years. The authors of the guidelines are currently updating them, as the CDC says that doctors have misinterpreted them. Deaths from overdoses continue to increase.

Patient care has been chilling. There are many reports of suicides by patients who have had their prescriptions reduced or eliminated. In an attempt to reduce risk to these patients from prescribed opioids, we may be killing some of them.

The health care workers who are afraid of legal trouble for them also become callous and cruel. Bill Kinkle, a former nurse, said that he was dumped out of a wheelchair onto the floor of the hospital because staff assumed that he was faking his inability to move so he could get drugs. He says that the neurosurgeon told him that if he didn't get medical attention soon, he'd be paralyzed.

A Harvard University addiction doctor was turned away from an E.R. because he was requesting treatment for sciatic pain. He was initially labeled a drugseeker by the E.R., before staff realized he needed help. The situation could have been different if he had his credentials.

As a journalist who covers this area regularly, I hear stories from families of dying people who are not being given appropriate relief and from people who, despite other approaches failing, can't get opioids for chronic or post surgical pain. The pendulum may swing back to a more humane form of pain care now that the Court has decided that doctors have the right to defend themselves.

The decision is having an effect on doctor prosecutions. One case has been dropped by the U.S. Department of Justice. Ronald Chapman said that in the case of David Lewis, the judge had to change jury instructions just as the decision was about to be read. All of the doctors were found not guilty on all counts the next day.

The decision could affect other cases where the government has criminalized the prescription of narcotics. Expanding access to these medications is one of the most effective ways to reduce overdose deaths, but what looks like lowering barriers to care from a public health perspective can seem to be drug dealing by doctors to police. Doctors who make it easier for patients to get addiction medication will face less legal threats.

The court rejected the government's claim that having to prove criminal intent will make these cases impossible.

It is easy for doctors to be scared into complying with what they think is the law. The case will hopefully make addiction and pain medicine more friendly to both doctors and patients.

The views expressed by the author or authors are not necessarily those ofScientific American.