Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What the media gets wrong when reporting on “overprescribing”

L. Joseph Parker, MD
Meds
December 24, 2023
Share
Tweet
Share

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. 

He can be reached on LinkedIn and YouTube.

Prev

Why clinical pathologists should learn poker theory

December 24, 2023 Kevin 0
…
Next

Uncovering the truth behind my father's tragic end

December 24, 2023 Kevin 1
…

Tagged as: Pain Management

Post navigation

< Previous Post
Why clinical pathologists should learn poker theory
Next Post >
Uncovering the truth behind my father's tragic end

ADVERTISEMENT

More by L. Joseph Parker, MD

  • The shocking truth behind the DEA’s role in America’s pain crisis and doctor prosecutions

    L. Joseph Parker, MD
  • How the DEA’s use of predictive algorithms is worsening crises in urban communities and raising suicide rates among African Americans

    L. Joseph Parker, MD & Neil Anand, MD
  • Why good doctors are being jailed—and what it means for you

    L. Joseph Parker, MD

Related Posts

  • On the internet, you are looking for something to make you angry

    Judson Ellis
  • Why social media may be causing real emotional harm

    Edwin Leap, MD
  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Why staying ahead of your pain with opioids is the wrong advice

    Myles Gart, MD
  • How I used social media to get promoted to professor

    David R. Stukus, MD

More in Meds

  • How medicine repurposing enables value-based pain management and insomnia therapy

    Olumuyiwa Bamgbade, MD
  • Forced voicemail and diagnosis codes are endangering patient access to medications

    Arthur Lazarus, MD, MBA
  • From stigma to science: Rethinking the U.S. drug scheduling system

    Artin Asadipooya
  • How drugmakers manipulate your health from diagnosis to prescription

    Martha Rosenberg
  • The food-drug interaction risks your doctor may be missing

    Frank Jumbe
  • Why retail pharmacies are the future of diverse clinical trials

    Shelli Pavone
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician
    • Why listening to parents’ intuition can save lives in pediatric care

      Tokunbo Akande, MD, MPH | Physician
    • Why financial planning is a critical tool for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician
    • Why listening to parents’ intuition can save lives in pediatric care

      Tokunbo Akande, MD, MPH | Physician
    • Why financial planning is a critical tool for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What the media gets wrong when reporting on “overprescribing”
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...