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Introduction
On a warm Father’s Day morning on June 19, 2011, 33 year old David Laffer, a
prescription painkiller addict, walked into a pharmacy in Medford, New York, pulled a .45-
caliber pistol out from a black knapsack, and shot and killed four innocent people in order to feed
his and his wife’s addiction to prescription painkillers. It was reported that before he left the
scene of the crime, he filled his backpack with more than 10,000 hydrocodone pills, opioid
painkillers used to treat moderate to severe pain. Police had even reported that the couple was
under the influence of narcotics when cops arrested them (Gardiner and Shallwani 2011).
However, what was even more troubling about this case is what came from the investigation
afterwards. Records showed that the couple had been prescribed a total of 4,251 prescription
pain pills in the first half of the year of the shooting. When investigators discovered the
enormous amounts of painkiller pills that were being prescribed to the couple, authorities turned
their attention to the doctors that had been prescribing the gunman with the massive amounts of
pain medication. Arrests were made for several of those doctors including, Dr. Eric Jacobson,
Dr. Frank Telang, and Dr. Stan Xuhui Li (CBS).
The silent epidemic of painkiller addiction and the involvement that doctors have in it is
an escalating issue in society and is insufficiently discussed in terms of everyday society. Instead
it is either sensationalized by the media or stigmatized by society. Unfortunately, the point at
which attention is usually drawn to the subject within society is typically when the doctors
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involved in prescribing painkillers to addicted patients begin to be blamed for the issue, and in
some cases even penalized. Society places a great deal of pressure on doctors and holds them to
an unrealistic standard. The co-occurring issue that society often overlooks concerning painkiller
addictions is the manipulation that doctors experience by prescription painkiller-addicted
patients. Patients that are addicted to prescriptions understand how to manipulate doctors in
order to keep a steady supply of their drug of choice. While a doctor is merely obliging by his
medical ethical obligations by treating the conditions of his patients, it is conceivable for him to
indirectly cause a separate condition in the process. When a doctor prescribes painkillers to a
patient thus treating the condition of that patient, the patient may subsequently become addicted
to the painkillers. When this occurs, the doctor is ironically both fulfilling and violating his
medical ethical obligations by simultaneously treating the pain condition and causing an
addiction. Although doctors may be both fulfilling and violating their medical ethical obligations
when they are prescribing painkillers to patients, the addicted patients are creating a relationship
of manipulation to maintain their supply of painkillers. Therefore, the growing trend in painkiller
addictions confirms that doctors should not be held entirely responsible for the addictions of their
patients. Instead, both doctor and patient must share equal blame in the matter.
Addiction In Society Today and Doctors’ Roles
Painkiller addiction is currently a prevalent issue in society; however, it is often
overlooked due to the taboo nature of addiction. The numbers of reported addictions to
prescription narcotics are on the rise. In fact, according to the National Institute of Drug Abuse,
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“7 million people were taking prescription drugs for nonmedical use in 2010. Among 12th
graders, prescription drug misuse is now second only to cannabis” (NIDA). The abuse of
prescription painkillers in society is now at its peak. Even as it is becoming quite common in the
high school-aged youth of our nation, it still manages to be a matter that is simply inadequately
discussed. Partially to blame for the silent quality of this silent epidemic is the scandal that
society has placed on drug addiction. In response to this scandal, Jolene Sanders, a scholar in the
field of the double standards in relation to the societal views of both genders and addiction,
writes in her article, "Use of Mutual Support to Counteract the Effects of Socially Constructed
Stigma: Gender and Drug Addiction," “stigma is heavily associated with being a drug addict…”
(Sanders 237). In society there is a tremendous level of shame that accompanies the taboo
concept of addiction. This is undoubtedly caused by the social stigma cast on drug addicts.
Although one of the primary aspects of addictions being stigmatized in society is due to the fact
that most known drug addictions are affiliated with illegal drugs, part of this stigma certainly
carries over in the case of prescription drug addictions. As a result of the taboo nature and social
stigma associated with addictions in general, the topic of addiction is seldom discussed although
it may be prevalent in most neighborhoods.
Concurrently to blame for the silence of the subject of prescription pain medication
addiction is the societal view of doctors. Society in general tends to associate doctors and
medicine with prestige. There is a tremendous amount of respect and admiration toward doctors
and parallel to this, there is a tremendous amount of pride in being a doctor. In the article, “What
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is Medicine and What is a Doctor? Medical Students’ Perceptions and Expectations of Their
Academic and Professional Career,” Medical students at the University of Cape Town were
questioned about their motivation behind wanting to become doctors. The authors, Catherine
Draper and Graham Louw, noted that students “were found to have generally positive
perceptions of medicine and doctors, and depicted the medical profession as one that is very
significant because of its influence within society, to the point of being perceived as almost
noble” (Draper and Louw 103). It stands out that the author uses the word ‘noble’ to describe the
perception of doctors. Nobility characterizes the conception of being virtually perfect which
doctors understandably are not. Doctors serve a crucial role in society and are placed on a
figurative pedestal where they are held under a false standard of perfection. They are honored
and respected. However, in the case of opiate abuse in patients, doctors may in fact be at the
epicenter of the issue. Conversely, due to the high status that doctors uphold in society, it is not
common for doctors to be discussed or viewed in an ill manner making their involvement in
prescription painkiller addictions taboo. A paradox exists in the subject of painkiller addiction in
society due to the fact that it is an extremely prevalent occurrence in today’s society and yet it is
rarely addressed due to the high level of integrity associated with doctors and medicine. In order
to open up new discussion concerning the issue of the rise in addiction to painkillers prevalent in
society, we must dismantle the idealistic portrayal of doctors in society.
Due to painkillers having the potential of the backlash of addiction tied to them, they are
becoming a taboo. Concurrently, doctors are receiving great condemnation because they, as
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ethical practitioners, are prescribing the painkillers to ‘treat’ patients and thus are causing the
patients’ addiction. Doctors are held responsible to diagnose and treat any condition upon
evaluation and inevitably, with this great responsibility, great pressure follows. Doctors are
placed on a figurative pedestal in the social hierarchy of society and are greatly idolized.
Conversely, while treating a preexisting condition, and thus obliging by the ethical obligations of
doctors, if a doctor were to collaterally cause another condition, society is quick to demonize the
doctor. In the perspective that doctors are responsible for painkiller addiction, the societal
idolization of them perpetuates the taboo nature of the addiction due to the respected nature of
the medical field, thus perpetuating the problem of the rise in painkiller addiction by inhibiting
us from finding a solution. Although doctors may unintentionally cause the patient to become
addicted when they prescribe painkillers to treat the patients’ pain, the patients are equally at
fault in the matter for manipulating the physician once they realize they are addicted to the
medication in order to greedily maintain their supply of painkillers.
There are occasional cases in which both the doctor and the patient are held accountable
in the issue as should be expected. In the case of the pharmacy fiend, David Laffer, as mentioned
previously, the addiction that both he and his wife had to opiate painkillers was in fact so severe
that it lead to the shooting of four unfortunate bystanders in a pharmacy prescription robbery
including the store clerk, the pharmacist, and two customers. In David Laffer and his wife,
Melinda Brady’s vain attempt to fuel their addictions to prescription medications, four lives were
lost. While at first this incident was viewed as a very unfortunate tragedy, baffling pieces of the
case began to surface. When it was discovered that the couple had been prescribed a total of
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4,251 prescription painkiller pills all within the first half of the year of the shooting, it was clear
that something was not right. Laffer and Brady were found to have gone through a prescription
addiction process known as ‘doctor shopping,’ seeking out dozens of doctors and visiting
different physicians as often as 11 times a month in attempts to seek out pain medication to fuel
their addictions (Gardiner and Shallwani 2011). Laffer and Brady were each manipulating
countless doctors into prescribing them more painkillers than a single person should ever be
prescribed in half of a year. While most of the doctors involved may not have known they were
being taken advantage of, it was believed by authorities that others did and those were the
doctors that were arrested. Subsequently, when the case went to court on September 8, 2011
Laffer was sentenced to five life terms in prison without parole for the four murders. His wife,
Brady who helped plan the robbery and drove the getaway car, was sentenced to the maximum
of 25 years in prison for robbery (Gardiner and Shallwani 2011). In the case of David Laffer,
although an extreme scenario, both the doctors prescribing the painkillers and the painkiller-
addicted patients were held accountable for the issue.
Although doctors have received adequate training in the field of prescriptions, what they
lack however, is the knowledge of all the potential jeopardies of consuming pain prescriptions,
addiction being one of them. While in medical school, students receive little to no education
regarding addictions and yet in their later careers, they are managing and prescribing addictive
substances to patients (Jones 132). By doctors overprescribing painkillers or prescribing them
recklessly without the knowledge of the potential effects it may have on the patient, they are
unknowingly abandoning the integrity of their degree. When a person graduates from medical
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school and earns a license to practice medicine, he is held at a certain level of responsibility for
the wellbeing of his patients. It becomes his role to both treat and protect his patients (Jones
132). At that, when prescribing pain medication to treat his patient, he may be abandoning his
duty to protect the patient by exposing the patient to the possibility of an addiction to the
painkillers. After all, it is physicians that carry a degree and are professionals in the field of
medicine. Although they may have not received a thorough education on addictions specifically,
they do however, have an acquired knowledge about medications and the risks involved that a
patient may not have. As professionals in medicine it is the doctors’ ethical duty to treat and
protect their patient.
The Psychology of Addiction
In the 21st century, addiction is not a habit but a disease. The inevitable question of why
drug users continue to use their drug of choice is due to the presence of this disease. In most
standard cases, an addiction corresponds to a drug use, whether the drug in reference be an illicit
or prescription drug. Addiction, or drug dependence, is a medical diagnosis and according to the
official guidelines for substance dependence, “the diagnosis of substance dependence is based on
experiencing at least three of seven clinical criteria in a one year period: 1) tolerance; 2)
withdrawal; 3) heavy drug use over an extended time period; 4) uncontrolled use; 5) effort and
time finding drugs, using them, and recuperating after use; and 6) reluctance to participate in
normal life events” (Freed 145). Similar to a doctor’s use of symptoms to diagnose a specific
illness, substance dependency can be diagnosed through an array of psychological evaluations.
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Because of the fact that addiction is classified as a disease, when a medication is prescribed to a
patient by a doctor and produces an addiction, it can be viewed as the doctor causing a disease in
the patient.
The long-term use of a drug will coincide with the body’s build up of a tolerance. As
addiction expert, Alfred Lindesmith describes in his book, which defines in detail the
qualifications of an addiction, Addiction and Opiates, “the reversal of effects and the apparent
paradox that the drug user continues his habit only to feel ‘normal’ become intelligible; indeed,
they become integral aspects of the habit” (Lindesmith 78). The paradox the author discuses is
when a person starts to use a drug, he does it to feel better than he does at the given moment.
This could pertain to his wishes of feeling ‘high’ or even pain relief. However, after continuous
use of the drug, the person’s body builds a tolerance to the drug and the initial pleasant sensation
brought on by the drug eventually diminishes to nonexistence. Instead, the user feels much
worse than when he started to use the drug in the first place and is almost forced to continue the
use of the drug just to feel a sense of normalcy.
Typically, symptoms of withdrawal are purely associated with illicit street drugs. This is
the sensation the body experiences while coming off of a drug. A description of withdrawal
symptoms is given by an addiction expert in the following: “…the abstinence symptoms; that
host of painful sensations, intolerable feelings, oppressive organic disturbances of every sort,
combined with psychic excitement, intense restlessness persistent insomnia” (Lindesmith 78).
The author mentions ‘the abstinence symptoms’ by these he is referring to the period of time
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after opiates have stopped being taken after a period of continuous use. The intense sensations
that the author describes are the symptoms of withdrawal. Withdrawal is the process through
which the body, and the brain specifically, first become deprived of the synthetic dopamine that
the opiate painkillers were providing for them, and the brain is unable to recollect how to
produce it naturally. The body essentially experiences a period of extreme pain and discomfort.
The patient is also often unable to sleep. The withdrawal symptoms pertaining to opiates are
very real and are often described as “unbearable” (Lindesmith 78). Withdrawal is one of the key
factors in determining the presence of an addiction.
Painkiller Addiction and Doctors in the Media
Although there is generally an idolization of doctors in society, sometimes this can cause
the inverse, a demonization of doctors. A widely known case in the media currently and an
excellent portrayal of the idolization of doctors in society being turned sour, is the case of the
death of the famous pop legend Michael Jackson and the link to prescription painkillers. On the
afternoon of June 25, 2009 Michael Jackson died of cardiac arrest that was later discovered to be
the result of his active use of a multitude of prescription medications. These prescription
medications were proscribed to the pop singer by his personal physician, Dr. Conrad Murray,
who was also present on the scene when the singer went into cardiac arrest at his Sunset
Boulevard estate. Dr. Murray was being paid $150,000 a month to live with and treat the singer.
In the toxicology report, at least six prescription drugs were found to be present in Jackson’s
system at his time of death. Immediately allegations pointed in the direction of Jackson’s
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physician, Dr. Conrad Murray. As soon as a month after the pop star’s death there was a report
saying that, “the police already have their working suspicions-and they could entail charges of
manslaughter” (Hewitt). Before the trial had even begun, the police had already assumed the
guilt of the doctor. They jumped to the conclusion that Dr. Murray was completely and solely
responsible for Michael Jackson’s death and failed to take into account the manipulative
intentions of Jackson as an addict to prescription drugs. This illustrates the demonization of
doctors on a legal level in cases involving doctors, who are responsible professionals, and
patients, who are generally viewed as victims. The case went to court on September 27, 2011
concerning the involvement of the doctor in the death of Jackson. According to New York
Times, “the trial had focused primarily on whether Dr. Murray was guilty of abdicating his duty
or of acting with reckless criminal negligence, directly causing his patient’s death” (Hewitt). As
a licensed physician, Murray was expected to make conscientious decisions in regards to the
treatment of Michael Jackson despite Jackson’s social status. As quoted by the New York Times,
“‘a stockbroker could use money as a tool to persuade doctors to give them pills," says Dr.
Carole Lieberman, a Beverly Hills psychiatrist who has treated dozens of celebrities addicted to
painkillers, "but celebrities have the added benefit that sometimes doctors become starstruck’"
(New York Times). It is significant that the article uses the term ‘starstruck.’ A doctor is a
licensed professional that is responsible for the patients that he is treating. It is extremely
unprofessional and reckless for a doctor to abandon his licensed duties because he is a fan of the
celebrity that he is treating. While it may be evident that Dr. Murray was influenced by
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Jackson’s status and money, it is not uncommon for common doctors to fall victim to the
pressure of manipulative patients (Ohira et al. 106). The verdict for the case was announced on
November 7 2011 after 22 days of testimony and about eight hours of reflection and debate.
Ultimately, Dr. Murray was convicted guilty of involuntary manslaughter and was sentenced to 4
years in prison (New York Times).
Within the media, affluence and fame glorify drug use, including that of prescription
medications. The substance abuse and euphoria are emphasized while the inevitable addiction is
overlooked. The abuse of prescription pain medication for casual use is abundant among
celebrities in the media. An even greater issue, however, is the fact that society seems to be more
fixated on, or more aware of, issues in the media, such as the abundance and glamorization of
painkillers in Hollywood, rather than on societal issues, such as the spike in prescription
painkillers in the neighborhood. As stated by The New York Times regarding Michael Jackson’s
prescription overdose, “Jackson's death has cast a harsh light on the subculture of prescription-
drug abuse that exists in Hollywood” (Hewitt). While prescription drug abuse may in fact exist
heavily in Hollywood, it is also among us in everyday society. It seems as though the painkiller
addictions and overdoses in the media are much more known and discussed in society than those
that exist in people’s everyday lives. Within society, prescription painkiller addictions are just as
relevant an issue as those that exist in the media. According to recent data, “pain is a presenting
complaint in over 80% of visits to physicians and contributes to significant health-care costs, yet
pain is often underrecognised and inadequately treated in primary care settings” (Walter,
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Mooney, Hillhouse 301). In a large percent of instances of visits to physicians where complaints
of pain are relevant, prescription painkillers are prescribed to the patient as a quick ‘fix’ to the
problem. Every day in society people are being prescribed pain medications that perhaps are not
always necessary. These medications may or may not lead to an addiction. Every time a
physician prescribes prescription pain medication to a patient, he is taking a gamble against the
patient’s wellbeing. Despite the commonality of painkiller addictions that are known and
unknown, there are still few precautions being taken against preventing future cases of
addictions.
Society is trapped between the glamorization of casual prescription drug use in the media
and the idolization of the prestige of doctors in society. The doctors, while on one hand,
represent what is moral and righteous; on the other hand, they are the providers of prescription
painkillers, the very source of the addiction. With corruption lurking in either path, society will
choose in which direction it wants to go. David Laffer chose to follow the path of doctors and
prestige when he became addicted to the medication that the doctors prescribed him and
ultimately, this led him to a path of corruption ending in the deaths of four people and the arrests
of five. Society ultimately has a choice of which path of corruption it choses to cross. To blame
for the inevitable corruption of society is both the doctors and the patients. The fault they both
have in common is the failure to make a change. The doctors fail to initiate a concrete system in
which records of patients’ additive and prescription history can be kept track of and accessed by
all doctors visited by the patient. The patient fails to choose to end the cycle once the addiction is
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recognized. Instead of making a change, the patient choses to manipulate the doctors and thus
continue the cycle of addiction.
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