In 2017, I learned of an active Medical Board of California (MBC) process, retrospectively reviewing all deaths where opioids have been implicated starting with 2012-2013. Through a memorandum of understanding with the California Department of Public Health, the “Death Certificate Project," as it became known, was created. The first step of the project identified 2,694 overdoses from 2012 and 2013. The MBC initiated 520 investigations against 471 physicians out of the state's 145,000 physicians, resulting in 66 MBC Accusations.

 

I have been able to offer support to some physician respondents who found themselves under scrutiny.

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Any physician who is faced with the disruption of their practice by such an investigation knows that preventing the formal investigation is the best solution. I have increasingly been asked to provide my expertise in reviewing and generating opinions on a growing number of these physician inquiries by the MBC.  I have helped in having charges dismissed or sanctions reduced, allowing my colleagues to continue practicing their specialty. Here is a link to reference a Timeline for Opioid Rx Standard of Care that I have created.

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The data on California deaths due to prescription overdose reveals a decline since 2014. While drug overdoses in California and the US continue to rise each year, now reaching over 100,000 persons, these deaths are not attributed to prescription drugs but rather to illicit drugs. I have been successful in illustrating in the several cases that the physicians who are being accused were simply providing the pain relieving services in accordance with the Standard of Care at the time the care was delivered.

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As the MBC has advanced the “Death Certificate Project” to another period of opioid related deaths, they are now focusing on 2019 cases. They have euphemistically renamed the project the "Prescription Review Program." In an effort to improve the quality of the analysis, the MBC is going to utilize the CURES database to review, “the entire prescription profile of the physician.”

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As this new phase in the process begins, we can anticipate continued challenges, including separating the patients who have overdosed due to a loss of access to prescribed opioids through the impact of the “anti-opioid” sentiment that has lead to many physicians simply ceasing to prescribe in order to avoid potential liability.

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I have seen the initial rise of opioid prescribing and the corresponding rise in opioid related deaths with the reactive regulatory responses now in play. Predictably, this opioid prescribing practice has become a pendulum swinging slowly, but forcibly impacting the lives of millions of patients and hundreds of thousands of physicians across the country.

 

My unique background has been essential in helping administrative law judges and juries understand that the prescribing behaviors of physicians need to be viewed in the context of longitudinal relationships with patients, those patients’ expectations and demands, as well as the evolving evidence of opioid related harms.