Death Certificate Project Goes Too Far, Addiction Specialist Says

Death Certificate Project Goes Too Far, Addiction Specialist Says

“Scaring providers into not prescribing opioids, I think that is not the ethically appropriate way to go forward,” said one addiction expert.

Dr. Ako Jacintho, a family practitioner in San Francisco, says that he saw the opioid epidemic coming. His patients were asking for stronger medications and more pills. Instead of filling their requests, Jacintho trained as an addiction specialist, hoping to head off the problem, according to NPR

However, that hasn’t protected him from an investigation that the California Medical Board is conducting into possible misuse of prescriptions. Jacintho received a letter from the board as part of the Death Certificate Project, which is examining death records in the state and seeking information from doctors who wrote prescriptions that may have contributed to fatal overdoses. 

In Jacintho’s case, the board wanted to know about a 2012 methadone prescription that he wrote for a patient who later fatally overdosed on methadone and Benadryl. Jacintho reviewed the patient’s records—which the medical board had requested—but stuck by his decision to use methadone to treat the patient’s pain. 

“If they’re looking for clinicians who are overprescribing, I’m the wrong doctor,” he said.

Jacintho said that it’s especially unfair to look at prescribing practices from seven years ago in light of our new understanding of opioids. In 2012, when he wrote the prescription, doctors were told to treat pain aggressively, even by the California Medical Board’s own recommendations. 

“It actually says that no physician will receive disciplinary action for prescribing opioids to patients with intractable pain,” Jacintho said. ”This person had intractable pain.”

The letter from the board alleged that Jacintho prescribed toxic levels of the medication, but the doctor argues that it’s not that clear cut. “Toxicity is a very subjective word. What’s a toxic level for someone may not be a toxic level for someone else.”

After the letter, Jacintho further reduced the amount of opioids that he prescribes to patients, something that worries Dr. Phillip Coffin, director of substance use research at the San Francisco Department of Public Health.

“It’s like leaving a pair of scissors in an abdomen after surgery. If you’re just going to discontinue opioids, basically you’re ripping out the scissors and telling the person: ‘Good luck.’ Let them deal with the intestinal perforation on their own,” he said. “Scaring providers into not prescribing opioids, I think that is not the ethically appropriate way to go forward.”

Kim Kirchmeyer, executive director of the medical board, said that most of the doctors who have received letters have not faced disciplinary action, although formal complaints have been filed against 25 doctors. She said that despite concern the death certificate project will continue, systematically working through records from previous years. 

“If we save one life through this project, that is meeting the mission of the board, and that makes this project so worth it,” she said.

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