Opinion: Patients suffer when doctors can face decades in prison for prescribing opioids
Xiulu Ruan, a board-certified Alabama pain specialist, was sentenced to 21 years in federal prison for prescribing opioid analgesics “outside the usual course of professional medical practice.” According to the appeals court that upheld his conviction, it did not matter whether he sincerely believed he was doing what a physician is supposed to do.
Ruan’s trial featured the usual battle of experts. Defense witnesses portrayed him as a conscientious physician doing his best to serve patients in dire need, while prosecution witnesses portrayed him as careless and blind to “red flags” indicating abuse or diversion of the drugs he prescribed. That demand puts doctors in a difficult position since pain cannot be objectively verified. If they trust their patients, some people will take advantage of that trust; if they reflexively treat their patients with suspicion, some people will suffer needlessly from pain that could have been relieved safely and effectively.
Criminal penalties traditionally are reserved for people who knowingly break the law. But the U.S. Court of Appeals for the 11th Circuit has held that a physician’s “good faith belief that he dispensed a controlled substance in the usual course of his professional practice is irrelevant” to the question of whether he violated the Controlled Substances Act.
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