What the media gets wrong when reporting on “overprescribing”

KevinMD.com

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.

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.

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.