The Doctor Is in…for 30 Years

In the cover story of Sunday's New York Times Magazine, Tina Rosenberg delves into the case of of Ronald McIver, a South Carolina physician who is serving a 30-year sentence for drug trafficking because some of his patients abused or sold painkillers he prescribed. McIver's situation is strikingly similar to that of Virginia pain doctor William Hurwitz, who received a 25-year sentence after his first drug trafficking trial, won an appeal that resulted in a new trial, and is now awaiting sentencing following his conviction on 16 drug-related charges. Both doctors were accused of reckless prescribing that supposedly killed patients whose deaths in all likelihood had nothing to do with the narcotics they received. In both cases, the doctors were too compassionate and too trusting for their own good, were arguably careless in the face of "red flags" suggesting addiction or diversion, but did not deliberately supply the black market or profit from illicit sales. Most of the people for whom they prescribed narcotics were legitimate chronic pain patients who considered themselves lucky to have found a doctor willing to prescribe the medication they needed to make their lives bearable.

Rosenberg treats McIver sympathetically but not uncritically, noting what she considers unwise decisions but arguing that such cases should be addressed through regulatory remedies rather than criminal prosecution. She does a good job of explaining how the war on drugs hurts pain patients, in the process puncturing various myths that contribute to undertreatment. The piece falls short mainly in failing to note that the tension between drug control and pain control is unavoidable: Because pain cannot be objectively verified, making sure that everyone who needs painkillers gets them in adequate doses inevitably means allowing a certain amount of diversion. One of the reforms Rosenberg endorses as an alternative to the DEA's heavy-handed prosecutions, comprehensive electronic monitoring of Schedule II drugs, could well aggravate the problem of inadequate pain treatment by making doctors more fearful of regulatory scrutiny and therefore more reluctant to prescribe narcotics. On the whole, though, Rosenberg's article is an important acknowledgment of the medical fallout from anti-drug hysteria fed by news organizations such as The New York Times.