RUTHFULLY YOURS

It was strange to see Hsiu-Ying “Lisa” Tseng in chains, but there she was: shackled, in purplish county-jail scrubs, heavy chains swinging across her belly. She doesn’t look like much of a menace to society; in fact, she looks exactly like what she is: an unimposing, middle-aged, female doctor in Rowland Heights, Calif., a Los Angeles suburb that is home to a large and largely well-off Asian-American community, mainly of Chinese, Taiwanese, and Korean background.

She is going away, for 30 years to life, sentenced late last week on three second-degree murder convictions related to deaths in which she did not have a direct hand, at murder scenes she was nowhere near. It’s the rest of the charges that tell the story: 19 counts of unlawful prescription of a controlled substance, one count of obtaining a controlled substance by fraud.

Dr. Tseng is the first physician to be convicted of murder for contributing to the current epidemic of prescription-opiate addiction — the motive force behind the national heroin epidemic — through her criminally wanton over-prescription of pharmaceutical painkillers. She probably won’t be the last: Dr. Gerald Klein of Palm Beach, Fla., was charged with first-degree murder under similar circumstances last year, though in the end he was acquitted of all but one relatively minor drug charge. Other cases are in the works.

Dr. John K. Sturman Jr. had his admitting privileges revoked in the state of Indiana in 2012, and he had earlier been disciplined by state authorities in California for his irresponsible handling of opiate prescriptions. Naturally — inevitably, really — he was hired by our corrupt and incompetent Department of Veterans Affairs, to work at a VA hospital in Danville, Ill., where his responsibilities included — can you guess? — implementing an “opioid safety initiative.” Last summer, he was charged with three homicides and 16 felony counts related to improper prescriptions.

He was arrested at a VA hospital management meeting.

Fifteen VA patients died of opiate overdoses under his care.

Last year, an extensive report by the Center for Investigative Reporting and the VA’s inspector general uncovered outrageous opiate abuses at a VA hospital in Tomah, Wis., that had come to be known among its patients as “Candyland.” “There were outrageous refills, patients who told us they lost their drugs for the fifth time,” former chief pharmacist Ron Pelham told investigators. One veteran, struggling with PTSD and alcohol addiction, sought treatment at the hospital, and his alcohol habit was cured with a prescription-drug habit. After he became a full-blown addict, he ended up committing an armed robbery and, as a condition of avoiding prison time, was ordered by the court to seek treatment — at the same VA hospital where he had become an addict in the first place.

That worked out about how you’d expect.

In New Orleans, emergency-room admissions for opiate overdoses were up 250 percent in December. Those were mainly from heroin. But, as chief medical officer Dr. Peter DeBlieux says, it is prescription drugs driving the heroin boom, not the other way around. Recent attempts to reform prescription abuses — from medical task forces to the relatively clumsy instrument of first-degree murder charges — have had some effect on the supply side of the market, but not on the demand side. Addicts stay addicts.

“They are driven toward alternatives,” Dr. DeBlieux says, “and heroin is one of those alternatives.”

A fair number of people become addicted to opiate painkillers after medical procedures. One addiction specialist talks about taking his daughter home from the hospital after a surgical procedure and being dismayed that she had been prescribed a quantity of painkillers that was “enough to addict her.” He himself was offered opiates after a procedure whose pain he counteracted with ordinary, over-the-counter painkillers no stronger than Tylenol.

But the doctor in the middle of the mess in Wisconsin wasn’t a pain specialist at all — he was a psychiatrist. Burn victims and cancer patients have serious pain and need serious painkillers. The psychiatric effect of these opiates is a medical concern, but it is an afterthought. Psychiatrists don’t prescribe for pain, usually — they prescribe for the psychiatric effects themselves. These patients were in psychic pain, not physical pain.

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There are several factors at play here. One is the interaction of the medical profession’s prestige with its arrogance: Patients are deferential to physicians and their advice, and the normal skepticism that regulators and oversight authorities would bring to, say, the manufacture of automobile airbags or the organization of commercial banks, often is partly suspended for physicians, who occupy the sanctum sanctorum in our national cult of expertise.

A second factor is that patients who are not deferential often are patients who complain. You know who doesn’t complain? A patient who is high out of his mind on oxy or knocked on his ass by Xanax. A stoned patient is a cooperative patient.

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The underlying moral calculus here will be familiar to anybody who has spent any time on a farm — or anybody who has had a pet dog, for that matter. When a sick collie or an injured horse is in pain and beyond help, we put them down to end their suffering. We do this in the name of mercy.

But veterans with PTSD aren’t injured racehorses. Poor people, alcoholics, and the mentally ill aren’t our pets, and we owe to them more than the simple pharmaceutical easing of their pain on their way to an early death via opiate toxicity.

What we have here isn’t just a prescription-drug problem: It is slow-motion euthanasia for the most vulnerable among us.

— Kevin D. Williamson is roving correspondent at National Review.

editor’s note: Kevin D. Williamson’s long-form report on the American heroin epidemic and its relationship to prescription-drug abuse will appear in the next issue of National Review, published on Friday.