A recent article in the Macomb Daily reported that a “Shelby Township doctor was convicted last Thursday of all counts for conspiring to distribute more than 300,000 opioid prescription pills valued at over $6 million, following a trial in U.S. District Court in Ann Arbor, according to federal authorities.”
This sounds very serious on its face. But without context, the public, and even we, have no idea what this means. Three hundred thousand pills over a period of ten years to a thousand patients would be an average of 2.5 pills per patient per month. If it’s only to ten patients over a ten-month period, then that’s 100 pills per day, and that would seem excessive, I think. Not the least because it’s not a practical number for the patient to keep track of. But what if these were 5 mg oxycodone tablets for ten patients dying of terminal brain cancer metastatic to the bone? 500 mg of oxycodone would be 750 MDE, but if that’s what it takes to make the suffering of these poor souls tolerable, even the CDC would agree that the normal limits do not apply.
Indeed, what if this doctor was only treating cancer patients, and he was using a more conventional fentanyl patch at the maximum of 100mcg/hr.? Which would be 240 MDE according to the MDCalc.com converter. If this doctor was only treating cancer patients as described and he was prescribing this medication as usual, he would only need to treat 104 patients in one year to reach the 300,000 number. But the errors are much worse than that. The article goes on to say that the doctor “issued more than 300,000 dosage units of Schedule II opioid prescriptions that had a street value in excess of $6.3 million, according to trial testimony, officials said.”
Now, we see a big problem if we look closely. The doctor did not prescribe 300,000 pills. He prescribed 300,000 “dosage units,” which would, of course, be morphine dose equivalents (MDE). An MDE, as we know, is a fraction of a pill. The 5 mg oxycodone mentioned above is 7.5 MDE as the oxycodone ratio is one to one point five, which would mean only 40,000 pills. However, the most commonly prescribed medication for pain is still hydrocodone 10/325. With the hydrocodone ratio being one to one, that means that just one pill of the most commonly prescribed pain medication is 10 MDE.
If all the doctor ever prescribed was this weakest of the most commonly used chronic pain medications, that would reduce the number of pills from 300,000 to 30,000. That makes a big difference. Now, just 1,875 patients treated for just 12 months at one pill every six hours or QID, the standard dose, would bring the doctor to 300,000 MDE. Context has taken what the public would perceive as an out-of-control pill pusher to a pain doctor whose prescribing is perfectly normal for moderate chronic pain, but if he’s treating patients with bone cancer, his prescribing would be so conservative as to put him at risk of a trip to Nuremberg. This is not an accident. I have been told by a respected historian researching the opioid crisis that the DEA told him personally that a morphine dose is equivalent to a pill or patch. It is my understanding that reporters have been told the same thing.
The DEA knows or should know better than this. If they do know, then they are actively and intentionally lying to the American public and poisoning the potential jury pool. If they do not know, then they are too misinformed to have the power to arrest physicians who treat pain. Let’s look a little further. The physician, age 74, “was found guilty of one count of conspiracy to illegally distribute pills such as Oxycodone, Oxymorphone, and Percocet, and 19 counts of illegal distribution of Oxycodone.” And goes on to say, “(He) …was the only prescribing doctor who primarily prescribed 30 milligrams of Oxycodone, 40 milligrams of Oxymorphone, and 10 to 325 milligrams of Percocet, three of the most addictive prescription opioids and among the most highly diverted prescription opioids due to their high street value, officials said.” Did some official really make such an asinine comment? 10 to 325 milligrams of Percocet? Or is the reporter too ignorant of medical issues to hear the statement properly? Percocet has 10 milligrams of oxycodone and 325 milligrams of acetaminophen. That’s Tylenol!
Now, the public is being told that the doctor was prescribing what would almost certainly be a lethal dose of hydrocodone when, in fact, this is a common combination pain medication. Finally, the article goes on to say that the doctor “… issued more than 300,000 dosage units of Schedule II opioid prescriptions that had a street value in excess of $6.3 million, according to trial testimony, officials said.” What expert said that? That would be $21 per MDE. So hydrocodone 10/325 goes for $210 on the street! I don’t think it has gotten that bad. If more knowledgeable scientists and physicians don’t start speaking out, these false statements will stand unopposed. The prosecutor went on to say, “My office remains committed to doing what it can to hold doctors and other health care professionals accountable when they illegally feed the opioid epidemic by writing illegal opioid prescriptions, rather than helping to address the terrible impact the opioid epidemic has had on our community,” he said in the press release. “We will pursue drug dealers whether they are peddling drugs on the street or while wearing white coats in a medical office.”
Physicians will spend decades in prison, not because they did anything unreasonable, but because politicians and law enforcement have no clue about the actual practice of medicine, and most of the media cannot be bothered with fact-checking what those in power tell them.
L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice. He currently serves as the chief science officer and operations officer, Advanced Research Concepts LLC, a pioneering company dedicated to propelling humanity into the realms of space exploration. At Advanced Research Concepts LLC, Dr. Parker leads a team of experts committed to developing innovative solutions for the complex challenges of space travel, including space transportation, energy storage, radiation shielding, artificial gravity, and space-related medical issues.