CONCORD — A Portsmouth doctor has been reprimanded and fined by the New Hampshire Board of Medicine after he cut back a chronic pain patient’s prescription opioid painkillers — and then dropped him as a patient altogether after the man threatened suicide.
Joshua Greenspan, who is board certified in pain management and anesthesiology, signed a settlement agreement in May to resolve allegations of professional misconduct. Greenspan did not respond to a message left at his office at the American Pain Institute on Friday.
According to a settlement agreement, the Board of Medicine received a complaint from a patient in June 2018, alleging that Greenspan, “after treating him for years and prescribing the same dosages of pain medication, suddenly reduced his medications, which led to increased pain and anxiety, and suicidal ideations.”
The case cuts to the heart of a growing controversy over recent federal guidelines for prescribing opioid painkillers. Chronic pain patients who have relied on prescription painkillers for years, sometimes decades, say they are being caught up in efforts by government agencies, doctors, pharmacists and insurance companies to reduce the volume of opioids being prescribed in response to the ongoing drug epidemic.
Chronic pain patients previously have told the Sunday News that many doctors in New Hampshire have begun “tapering” them off the medications that allow them to go about their daily lives. And they say some patients have taken their own lives.
The Centers for Disease Control and Prevention estimates that 19.6 million Americans suffer from “high-impact” chronic pain, defined as pain that interferes with daily life or work activities.
In the recent Board of Medicine case, the patient has suffered chronic pain for years and had been a patient of Greenspan since 2014.
A previous doctor had prescribed 80 mg of Oxycontin twice daily and 30 mg of Oxycodone four times a day, and Greenspan continued to prescribe those painkillers at the same doses.
Greenspan checked the prescription drug monitoring database, which tracks prescriptions of controlled drugs, and the patient was subject to urine tests and pill counts to make sure he wasn’t misusing the medications, according to the settlement.
On April 9, 2018, Greenspan informed the patient that the Centers for Medicare and Medicaid Services (CMS) had issued new guidelines that allowed doctors to prescribe only up to the equivalent of 90 mg of morphine a day. He told the patient that he was reducing his dosage of Oxycontin to come into compliance with those guidelines, and cut the man’s daily dosage by 40 mg.
The board’s order noted that the CMS guidelines did not actually set an upper limit but required pharmacists filling prescriptions for higher amounts of opioids to discuss such cases with the prescribing physicians.
According to the settlement documents, Green- span’s patient reported that his pain was not controlled by the lower dosage and he was having a “tough emotional time.” Later that year, the patient failed a pill count and was admitted to a hospital for threatening suicide.
That’s when the doctor told the patient he was no longer comfortable prescribing opioids for him and would no longer treat him. He also “reported his concerns about (the patient’s) well-being” to the local police department and the man’s primary care doctor, according to the settlement. He also sent a prescription for an opioid withdrawal drug to the patient’s pharmacy.
The board found that Greenspan’s handling of the case violated ethical standards of professional conduct. In addition to reprimanding him and fining him $1,000, the board required him to participate in at least 12 hours of education in prescribing opioids for pain management and in pain management record-keeping.
Bill Murphy, a Hooksett man who is active in the Don’t Punish Pain movement, called the Board of Medicine’s action “a great step in the right direction.”
“It just sends the right message to physicians in New Hampshire that the guidelines are just that — guidelines — and not hard and fast rules,” he said.
It’s a message doctors need to hear, as many fear being disciplined for prescribing too many opioids, Murphy said.
“I think in the end they do want to help people,” he said. “They feel like they’re caught between a rock and a hard place.”