Time to Take a Look at the Man in the Mirror

[Editor’s Note: This piece originally appeared as part of Pain Management’s coverage of PAINWeek 2011. Pain Management is a sister publication of Pharmacy Times.]

The criminal trial for Michael Jackson’s physician, Conrad Murray, MD, is set to begin on Tuesday, Sept. 27, and is expected to continue until Thanksgiving. Murray is accused of involuntary manslaughter in the pop star’s June 2009 death. The Los Angeles coroner ruled the cause of death to be an overdose of the surgical anesthetic propofol, combined with other drugs, and Murray is accused of administering the fatal dose. The trial will be televised.

The Murray trial will reveal two urgent US public health crises that go hand in hand: undertreated pain and prescription drug abuse. The facts of the case will establish that Jackson was a legitimate patient with complex health care needs. They will expose what the Institute of Medicine reported in June to be systematic failures of the US health care system to adequately treat patients with pain. The inadequate and improper treatment of pain contributes directly to prescription drug diversion, misuse, and abuse. Drug overdoses have risen 5-fold over the last 2 decades.

Murray’s defense team has two of Jackson’s former doctors and one nurse practitioner on its witness list, all of whom will likely be called to testify at the trial. The prosecution has asked the judge to review medical records for Murray’s other patients to decide whether they could be used in the trial to demonstrate the doctor’s prescription practices. As Jackson fans and news buffs tune in to the trial, terms like “doctor shopping,” “pill mill,” and “script docs” will become part of mainstream vocabulary.

Jackson’s family, friends, and business associates report that he was addicted to powerful prescription medications and that those medications led to his untimely death. Through the Murray trial, the world will learn the graphic details of drug seeking and misuse of medications, improper prescribing and dispensing, and the tragic loss of a beloved entertainer. In this regard—and perhaps only in this regard—Michael Jackson’s story was not unique. Prescription drug abuse is not confined to Hollywood. Drug overdoses claim the lives of some 27,000 Americans each year, according to the CDC.

A sincere assessment of our nation’s prescription drug problem must start with the man in the mirror: the concerned mom who shares her leftover pain relievers with her daughter, the driven university student who takes his roommate’s pills to gain an edge for an exam, and the busy medical practitioner who simply has not taken the time to research the right medication for her patient’s condition. We must improve the way we use, store, and dispose of prescription medications. The national conversation surrounding the Murray trial must also encompass the need to advance public policy and professional practices to improve medical care and prevent prescription drug overdoses. A bill currently before Congress could move us closer to these goals.

US Representative Mary Bono Mack (CA-45), along with Reps. Hal Rogers (KY-05) and Stephen Lynch (MA-09), have introduced HR 2119 to require all prescribers of controlled substances to have minimal education on safe prescribing. Under current federal law, state-licensed prescribers must register with the Drug Enforcement Administration (DEA) every three years for federal authority to prescribe controlled substances. There are no federal educational requirements related to assessing risk, prescribing cautiously, monitoring patients, and detecting addiction and abuse. HR 2119 would implement the recommendations of the White House drug policy office, 2 of the FDA’s outside-expert advisory committees, and more than 25 not-for-profit health and safety organizations and professional associations.

The charge against Murray is involuntary manslaughter, the crime of unintentionally killing a person. In other words, prosecutors believe, based on the evidence in the case, Murray did not mean to kill Jackson. Regardless of the outcome of his criminal trial, Murray should have known and done better. More thorough professional education could have helped.

As Americans await the Murray trial to find out what really happened to Michael Jackson, millions of other lives are shattering, though far less publicly, in a similar way. Nearly 75,000 Americans have died after Michael Jackson under equally tragic yet avoidable circumstances. The Murray trial provides an opportunity for our nation to take a look at itself and then make a change.

Michael C. Barnes is an attorney and policy advisor with DCBA Law & Policy, and serves as interim executive director of the not-for-profit Center for Lawful Access and Abuse Deterrence.