Murder by Opioid: The Case of the Ohio Doctor Charged With 25 Counts of Murder

Lin Rice

October 01, 2019

Ohio's Response to the Opioid Epidemic

Given the heightened scrutiny and the direct impact on nurses and others related to this case, one might expect clinicians across the area to be looking over their shoulders when it comes to prescribing or administering opioids. But doctors interviewed for this article pointed to the broad efforts by government to stem the opioid epidemic as having had a more chilling effect than this single case, which they view as an outlier. They describe the scrutiny of practice, as well as responses on the part of not just healthcare professionals but courts, legislatures, and the public, as having had consequences that have led to far bigger changes in practice.

All acknowledged the devastating mark that the crisis has left on Ohio. From 2014 to 2016, the state led the country in number of deaths due to opioid overdose.

According to a Drug Enforcement Administration database recently published by the Washington Post, about 3.4 billion prescription pain pills flowed into Ohio between 2006 and 2012. The surge of pills hit its peak in 2010, when providers wrote 102.4 opioid prescriptions for every 100 Ohioans.

In 2013, overdose deaths attributed to fentanyl and related drugs accounted for about 4% of the total. That figure climbed to more than 70% of overdose deaths by 2017.

The state has responded with a range of new rules and regulations. "Ohio has been one of the most progressive states, in terms of addressing opioid prescribing, in the country," Dr Mark Hurst, medical director of the Ohio Department of Health, told Medscape.

In the past several years, many state-specific guidelines were created for the use of opioids, Hurst says. These guidelines have been codified into medical board administrative rules, allowing for their enforcement. Hurst says that the rules were crafted to give physicians enough room to treat patients in need of high dosages, or for extended periods.

The Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain , released in 2016, was widely panned owing to concerns that it limited clinician judgement and potentially hurt patients with chronic pain. Hurst emphasized that Ohio's guidelines were already being developed when the CDC's guidelines came out—and before criminal charges against Husel. "Nowhere do [Ohio guidelines] set an arbitrary dose or duration limit; there are checkpoints and guidelines, but if a physician needs to exceed those for a certain patient, they can do so by documenting it appropriately, and in some circumstances doing some double-checking."

When asked whether the rules would be revisited because of the Husel case, Hurst said they are required to be reviewed every 5 years. Acute pain rules went into effect in Ohio in 2017 and chronic pain rules in 2017.

"I don't think there's a correlation between the rules and the Husel case, and I should probably leave it at that," he said.

State representative Beth Liston, MD, a practicing physician and an associate professor of medicine with the Ohio State University, says much effort has been put into making the state's guidelines flexible for circumstances outside the norm.

"The law is a pretty blunt tool, where medicine is always gray, and people are individualized," Liston says. "I think understanding that bluntness has reinforced the sense of making sure that [the state] doesn't, even in a well-intentioned way, impede care by implementing something that's all broad strokes."

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