Editorial

Will Recent Murder ChargesFiled Against Physicians forOpioid-Related Deaths AffectPain Management?

In a recent article, Gevirtz (2012) mentions two

murder cases that were recently prosecuted. One

case involved a physician who allegedly was falselyprescribing oxycodone, alprazolam, and other drugs

that are commonly abused. As reported in the Los

Angeles Times (2012), three undercover investigators

tied this physician to three overdose deaths.

In the second case, a drugstore was robbed which

resulted in the murder of a pharmacist, a cashier,

and two customers. The robbery was committed by

a drugs-seeking couple. After the murders, the pre-scribing physician, who ran a pain clinic, was charged

by the state Department of Health with gross negli-

gence, gross incompetence, and moral unfitness. The

physician was charged with multiple counts of the

criminal sale of a controlled substance. The paper

Newsday (Van Sant & Lewis, 2011) reported that in

a period of 6 months the couple had filled seven

prescriptions for nearly 840 hydrocodone tabletsprescribed by one physician.

Lankenau, Schrage, Silva, Kecojevic, Abloom,

Wong, & Iverson (2012) interviewed 596 young adults

(16-25 years old) who had misused prescription drugs

within the previous 90 days. Face-to-face interviews

were conducted in Los Angeles and New York. The

participants were typically white, male, and hetero-

sexual. Most were currently homeless or unemployed,or had been arrested. The most frequently misused

opioids included hydrocone, oxycodone, and codeine.

Xanax was the most frequently misused tranquilizer,

followed by valium and klonopin.

A Centers for Disease Control and Prevention

report (2012) describes an increase in the number of

prescriptions for opioids over the past decade. People

that abuse opioids have learned to exploit this ten-dency to prescribe opioids for a patient’s pain. Among

patients who are prescribed opioids, it is estimated

Pain Management Nursing, Vol 13, No

that 80% are prescribed a dose that is too low (<100

mg morphine equivalent) by a single prescriber. These

patients account for 20% of all prescription overdoses.Single prescribers have been found to prescribe

high doses (>100 mg morphine equivalent) 10% of

the time. This accounts for 40% of prescription over-

doses. After review of the data, it was suggested that

prevention of opioid overdose deaths should focus

on strategies that target high-dosage medical users

and persons who seek to divert drugs, receive high

doses, and seek care from multiple physicians.The cases described are actually few and far be-

tween, because most prescribers are following best

practices by conducting physical examinations, taking

careful histories, following best practices for documen-

tation and clearly communicating with patients about

mutual responsibilities for the prescriptions (Gevirtz,

2012). In the present issue, you will find the Addic-

tions Position Statement, which was a joint projectconducted by the American Society for Pain Manage-

ment Nursing (ASPMN) and the International Nursing

Society for Addictions. This document addresses the

public health concerns of substance misuse as well

as the health issue of adequate pain management.

The document stresses the patient’s right to pain relief.

Recommendations are made for patients at low,

moderate, and high risk for addiction. There are practi-cal recommendations for nursing practice, prescriber

practice, and institutional policies. There is an excel-

lent discussion of different treatment options. Re-

sources for recommended reading and a list of useful

websites are presented. Please share your copy with

a nurse.

Joyce S. Willens, PhD, RN, BCCollege of Nursing, Villanova University

Villanova, Pennsylvania

3 (September), 2012: pp 125-126

itorial

126 Ed

REFERENCES

Centers for Disease Control and Prevention (2012).

Morbidity and Mortality Weekly, 61(1), 10–13.Gevirtz, C. (2012). Stakes rise as murder charges are filed

against physicians for opioid-related deaths. Topics in Pain

Management, 27(12), 6–7.Los Angeles Times (2012). Judge not swayed by tears in

doctor’s prescription pad murder case. March 16.Lankenau, S. E., Schrage, S. M., Silva, K., Kecojevic, A.,

Bloom, J. J., Wong, C., & Iverson, E. (2012). Misuse of

prescription and illicit drugs among high-risk young adultsin Los Angeles and New York. Journal of Public HealthResearch, 1(1), 22–30.Van Sant, W., & Lewis, R. (2012). David Laffer doc charged

in overdose case. Newsday. November 21.

� 2012 by the American Society for Pain Management Nursing

http://dx.doi.org/10.1016/j.pmn.2012.07.003