No Winners

Here is another story about a doctor convicted of overprescribing, which led to the death of a patient, and this 71 year-old is going up the river for a likely 20-year term.  U.S. Attorney Ben Glassman brags, “We’re going to investigate those doctors. They’re going to be tried, and … they’re going to be finding themselves in prison for a long time.”  Dr. Saad Sakkal was convicted of illegally distributing and dispensing controlled substances, which reportedly led to the death of a patient.  This patient was found dead, with a boatload of oxycodone and Xanax in her system, both of which she had obtained scripts from Sakkal the day before.  The defense argued that it was the dead woman’s fault, because she took more than was prescribed.  The prosecution argued that the fault was with the doctor for (re)prescribing to an obvious junkie, a position bolstered by an angry family wanting justice.  Obviously, all three parties were correct.  

Sakkal had led protests outside pharmacies that refused to fill his controlled scripts, which probably weren’t amused by the combo names in the indictments:

  • Holy Trinity, which consists of an opiate, a benzodiazepine and a stimulant
  • Prescriptive Speedball, which includes an opiate and a stimulant
  • Triple Threat Heaven, which consists of methadone, a benzodiazepine and a stimulant.

Count me ignorant, but I didn’t know that combo slang.  I also didn’t know until yesterday that big pharmacy chains are now refusing more than 50 Morphine milligram equivalent (MME) daily doses.  This was a callback from another physician’s prescription, as I NEVER wrote that much even before the “crisis”, but now pharmacy chains have corporate limits set by hiding behind the CDC guidelines. 

 Where does this week leave us?  There are opioid deaths occurring due to patient misbehavior, and this will not change, no matter how much the White House screams about “crisis!”  There are scumbag docs out there operating sleazy pill mills who do contribute to the addiction and death of patients.  There are angry, vengeful families and ambitious prosecutors who will use awful cases to further restrict honest doctors.  They will be assisted by corporate interests as all of society continues to substitute its feelings and frustrations for the clinical judgment of competent, trained physicians.  Perhaps the worst aspect of this case is that it will further entrench in everyone’s mind that doctors are not to be trusted.  It is no excuse or sympathy for the Sakkal’s of the world to observe that all of these worsening trends will be blamed on those trained to alleviate pain.  Gloomy times, indeed.

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  1 comment for “No Winners

  1. Kurt
    April 24, 2019 at 3:50 pm

    Can’t wait to retire in 2.5 years. Once had a female patient who survived and beat 5 cancers but couldn’t give up smoking. Oncologist kept her on narcs for years . When she ran out of lung tissue to support life, I had to put her on a narcotic drip. I had to give her 460mg of morphine equivalents PER HOUR! To keep her comfortable.
    My prior record was a man I inherited from outside the area on a morphine drip due to metastatic prostate cancer and diffuse bone pain. He was on 200mg/hr morphine equivalents. I saw him and he was watching a Cubs ballgame with family present. Perfectly lucid and comfortable. He and his family thanked me for taking him on and I thought he had awhile to go. Was a DNR and I was surprised to be called that he passed in his sleep 2 days later. He had been on 200mg an hour for a month and was habituated.
    It’s a good time NOT to go into primary care medicine. Blame the doctors for everything.
    There are ~328 million or so souls in the US now. Do you think a few more have been born with a genetic tendency to abuse narcs in the last 25 to 30 years? Last I heard docs can’t prescribe heroin.
    I had the pleasure of taking care of a couple of narc abusers in the hospital for unrelated conditions who were in a federally approved methadone program. One was on 600mg of methadone a day and the other 480mg/day! I called the program director who confirmed this. There is a line of thinking in methadone therapy to give the patients whatever the h#ll they want and it keeps them from shooting heroin (or herion as I used to see addicts spell it in a methadone I moonlighted in 35 years ago. Back then 10mg of methadone would keep an addict out of withdrawal.)
    There is a big disconnect here.

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