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Doctor charged with manslaughter in opioid overdose death

In this Oct. 22, 2018 file photo, a fentanyl user holds a needle near Kensington and Cambria in Philadelphia. Suicides and drug overdoses helped lead a surge in U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live. U.S. health officials released the latest numbers Thursday, Nov. 29. Death rates for heroin, methadone and prescription opioid painkillers were flat. But deaths from the powerful painkiller fentanyl and its close opioid cousins continued to soar in 2017. (David Maialetti/The Philadelphia Inquirer via AP, File)
David Maialetti/The Phildelphia Inquirer via Associated Press/File
Dr. Richard Miron is accused of continuing to authorize large doses of opioids and other drugs even though he knew the victim had overdosed in February 2016 on opioids he had prescribed.

A Dracut physician has been charged with involuntary manslaughter in the 2016 death of a woman who overdosed on opioids that he had prescribed, the first such indictment in the state, authorities announced Tuesday.

Dr. Richard Miron is accused of continuing to authorize large doses of opioids and other drugs even though he knew the victim had overdosed in February 2016 on opioids he had prescribed. Attorney General Maura Healey said Miron is charged with prescribing opioids without legitimate medical purpose.

According to Healey’s office, the medical examiner determined that his patient, a woman who was not identified, died on March 17, 2016, from acute intoxication from the combined effects of fentanyl, morphine, codeine, and butalbital (a barbiturate), all prescribed by Miron.

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Miron’s alleged actions were particularly brazen: From September 2015 to February 2016, he prescribed more high-dose, short-acting oxycodone prescriptions than any other provider in the state’s Medicaid program, according to the attorney general’s office.

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Miron, 76, was also charged with defrauding the program, known as MassHealth. Attempts to reach Miron on Tuesday were unsuccessful. He will be arraigned in Middlesex Superior Court at a date not yet set.

The charges are the second move by law enforcement in recent days related to opioid prescribing, which has been blamed for triggering an addiction epidemic that led to more than 2,000 deaths last year.

Late last month, US Attorney Andrew Lelling wrote to an undisclosed number of medical professionals warning them that their prescribing practices were being closely watched because they had prescribed opioids to a patient within 60 days of that patient’s death or to a patient who had died from an opioid overdose.

The surge in opioid prescriptions that started in the late 1990s coincided with a parallel growth in overdose deaths, as pain pills became widely available. Some doctors were prescribing without sufficient attention to the risks. But the vast majority of people who take opioids don’t become addicted, and many people got the drugs from friends or stole them, rather than obtaining them from their own doctor’s prescriptions.

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As the rules have tightened and awareness has grown, opioid prescribing in Massachusetts decreased by 35 percent over the past three years.

Yet the rate of overdoses has changed little, as the powerful illicit drug fentanyl infiltrates the street supply. Prescription opioids are found in the bodies of fewer than a fifth of those who fatally overdose, while the street version of fentanyl is a factor in 90 percent of those deaths.

That has led some to criticize the focus on prescribing rather than other factors that drive addiction. Meanwhile, patients in pain complain of difficulty finding a doctor who will alleviate their suffering.

Although Miron’s case is the first such manslaughter indictment by Massachusetts authorities, doctors elsewhere in the country have faced manslaughter and even murder charges for illegal prescribing.

In a famous Los Angeles case in 2016, Dr. Hsiu-Ying “Lisa” Tseng was sentenced to 30 years to life in prison for the murders of three of her patients who fatally overdosed. More recently, in June of this year, Dr. Lawrence Choy was arrested by New York City and federal authorities and charged with 231 counts related to opioid prescribing, including two counts of manslaughter in the second degree.

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Criminal charges against prescribers have increased, but they remain quite rare, said Y. Tony Yang, professor of health policy at George Washington University.

Yang’s analysis of data from the National Practitioners Data Bank, a compendium of disciplinary actions against medical professionals, found that Drug Enforcement Administration actions against doctors increased about fivefold from 88 cases nationwide in 2011 to 449 in 2017. Since then, he said, cases have held steady.

Yang said he doesn’t think doctors are becoming scapegoats in the opioid crisis. He called the rare criminal convictions “a positive step that may deter future dangerous prescribing.”

The “involuntary manslaughter” indictment against Miron — handed up Thursday by a Middlesex County grand jury — means that he is accused of a killing that was not premeditated or intentional. He faces 23 counts of illegal prescribing of controlled substances, 23 counts of filing false claims for Medicaid reimbursement, and the one count of involuntary manslaughter in the woman’s death.

Miron was dropped from MassHealth in September 2017, and on Nov. 30 of this year he entered into a voluntary agreement with the Board of Registration in Medicine to stop practicing medicine.

Healey’s office began its investigation in September 2017 after a referral from MassHealth.

Investigators allege that Miron, in multiple instances in addition to the woman who died, prescribed oxycodone, morphine, fentanyl, methadone, and hydromorphone to patients for no legitimate medical purpose, including to some patients with documented substance use disorders.

Tests that Miron ordered and reviewed showed that his patients had taken no prescribed opioids but had taken cocaine and heroin or other nonprescribed opioids.

Miron allegedly continued to prescribe opioids to those patients, and the illegal prescriptions caused pharmacies to unwittingly falsely bill MassHealth for the medication.

Correspondent Morgan Hughes contributed to this report. Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer