US attorney issues warning to physicians over opioid prescriptions
US Attorney Andrew E. Lelling has sent letters to “a number of medical professionals” alerting them that their opioid prescribing practices “have been identified as a source of concern.”
In a statement released Thursday, Lelling said that the professionals who received the warning had prescribed opioids to a patient within 60 days of that patient’s death or to a patient who subsequently died from an opioid overdose.
The letters inform the professionals that it’s illegal to prescribe opioids “without a legitimate medical purpose, substantially in excess of the needs of the patient, or outside the usual course of professional practice,” according to the news release from Lelling’s office.
He declined to provide the Globe with a copy of the letter and also would not say how many letters went out.
“We’re going to be doing this on an ongoing, regular basis,” said Christina DiIorio-Sterling, Lelling’s spokeswoman.
Lelling’s press release states that his office has “made no determination that the prescribers receiving these letters have violated the law.” Instead, the hope is to encourage professionals “to take stock of their prescribing practices and make any necessary adjustments.”
“The letter was meant to alert them that they’re on our radar,” DiIorio-Sterling said. “It’s a serious warning.”
But Leo Beletsky, an associate professor of law and health sciences at the Northeastern University School of Law, called the move “a blunt tool that sends waves of terror through the prescriber community. It shifts prescriber behavior in ways that hurt patient care.”
As a result, he said, doctors are often afraid to prescribe pain medications to patients who need them.
“It’s a solution in search of a problem because the crisis no longer even involves prescription drugs primarily. It’s driven by fentanyl,” Beletsky said.
State data show that prescription opioids are found in the bodies of only 17 percent of overdose victims while 90 percent had taken the powerful synthetic fentanyl, a street drug. (Many drug users take more than one substance simultaneously.)
Dr. Alain A. Chaoui, president of the Massachusetts Medical Society, noted in a statement that opioid prescriptions have already declined 35 percent over the past 3½ years, and there was “an even higher reduction in first-time opioid prescriptions.”
“We stand behind physicians providing evidence-based care to the sickest, most vulnerable patients,” Chaoui said. “We remain dedicated to promoting best opioid prescribing practices, and we urge all concerned parties to join us in expanding addiction treatment and fentanyl-driven overdose prevention.”
Asked about these comments, Lelling said in an e-mail that the decline in prescribing is no reason to pull back.
“In the midst of a national crisis killing thousands a year, we must take steps to stem the flow of opioids,” he said. “No doctor properly prescribing should have cause for concern.”
In February, then-Attorney General Jeff Sessions formed a Prescription Interdiction and Litigation Task Force to “deploy and coordinate all available criminal and civil law enforcement tools to reverse the tide of opioid overdoses,” including pursuing doctors and pharmacists who break the law in prescribing opioids.
The US attorney in Atlanta sent a similar letter to 30 doctors in northern Georgia last October. DiIorio-Sterling said that other districts have taken similar actions without publicizing it.
In an experiment published in August, doctors in San Diego County cut back on opioid prescribing by about 7 percent after receiving notices from the medical examiner that their patient had died of an overdose.
A 2015 study in Massachusetts found that more than 90 percent of people who survived an overdose on prescription opioids were able to obtain another prescription for opioids soon afterward. The researchers speculated that the doctors did not know their patients had overdosed.
“The opioid crisis is killing tens of thousands of people a year, including thousands in Massachusetts,” Lelling said in a statement. “One source of opioids — used for both legitimate and illegitimate purposes — is medical professionals, who have an obligation always to act in patients’ best interests.”