The Chilling Effect: How Fear Drives Doctors Away from Pain Patients

Opioid addiction is a leading cause of avoidable death in America, but the war on opioid medications which ensued has created a new class of victims, some of whom commit suicide:

https://www.cato.org/blog/chilling-effect-how-fear-drives-doctors-away-pain-patients

The Chilling Effect: How Fear Drives Doctors Away from Pain Patients
By Jeffrey A. Singer - February 25, 2025

When Mark Ibsen, MD, spoke as a panelist in the Cato online event “Pain Refugees: Collateral Damage in the War on Drugs” last December, he had no idea that representatives of the Montana Board of Medical Examiners (BOME) were watching. Three days later, he was shocked to receive a letter from BOME demanding he justify mentioning deceased patients by name (possibly violating the Health Insurance Portability and Accountability Act, or HIPAA)—a charge that would later be dropped but sent a clear message: speaking out has consequences. The letter stated:

While investigating the original Complaint, the Department became aware that you identified six former patients by name in the following online forums, which were available to the public:

1) December 22, 2019, written post responding to a blog article entitled “No Help, no medication. I want out. I’m not strong enough” on the Pharmacist Steve website.

2) October 6, 2020, video post on your Facebook page.

3) December 2, 2024, video post on your Facebook page.

4) December 3, 2024, panel discussion hosted on the Cato Institute’s website and video post of the panel discussion on that website.

… Please provide a written response to these additional allegations by the end of the day on December 16, 2024. Please include in your response whether you had written permission from your former patients or other legally authorized individual to disclose the patient’s protected health information in a public setting. If so, please provide copies with your response. (emphasis added)

In 2015, agents from the Drug Enforcement Administration (DEA) raided the office of Christopher Christensen, a Montana physician who was then 67 years old, and arrested him for inappropriately prescribing opioids to his patients. The DEA charged Dr. Christensen with 400 felony drug offenses and two counts of negligent homicide following the overdoses of two patients who had taken his prescribed medication. A jury convicted Christensen in 2017, and the court sentenced him to 20 years in prison, 10 of which were suspended. The Montana Supreme Court overturned the negligent homicide convictions but still required him to serve time in prison for nine counts of criminal endangerment and 11 counts of criminal distribution of dangerous drugs.

Dr. Christensen’s arrest by cops practicing medicine frightened Dr. Ibsen, a Montana primary care and urgent care physician. Dr. Ibsen wrote me: “Before ceasing writing prescriptions for opiates, reported DEA incursions had me thinking that every opiate prescription I wrote could be my last. I worried if I could trust patients to honor their promise that they would not kill themselves with my prescription, as that would take me down as well.” He ceased prescribing opioids for pain in 2017. “I thought I was going to be given an award for weaning 80% of my patients off opioids.”

He tapered his patients’ doses, gave them notice that he would no longer treat them, referred them to other doctors, and prescribed them a 30-day supply of pain medications to tide them over until they saw the other doctors. Unfortunately, other doctors were oftentimes afraid of taking on new pain patients. Some of Ibsen’s former patients grew desperate, and like many across the country in similar straits, some turned to suicide.

At Cato’s pain refugee event, Dr. Ibsen, holding back tears, stated:

Six of my patients died from 2016 to 2018 after I stopped prescribing opiates when Dr. Chris Christensen was convicted. Three of my patients died by gunshot wounds … two by alcohol complications … and one by a non-opioid overdose: Chris Storseht — Jennifer Adams – Robert Mason – Jennifer Beausoleil – John Burke- Lynette Chadwick.

At the BOME Screening Panel hearing this month, the BOME attorney never mentioned HIPAA violations when summarizing the Board’s concerns. The physician chairing the panel didn’t mention HIPAA violations either.

One of Dr. Ibsen’s chronic pain patients from 2013 provided an affidavit stating:

Information, pictures, and names of chronic pain patients who committed suicide, have been public knowledge for a number of years. … There was a conference put on by the Helena Department of Public Health & Human Services in 2018. A few of us chronic pain patients that belong to an organization called “Don’t Punish Pain” were invited to be on a panel. We talked about, (six) chronic pain patients just in Montana! We held up their pictures as we said each of their names.

But the affidavit wasn’t needed. The panel voted to terminate the investigation.

This might end the Board’s persecution of Dr. Ibsen, but he will always be haunted by the memories of pain patients who suffered so much that they took their own lives.

Ibsen’s story is emblematic of a broader pattern: regulators and law enforcement drive physicians out of pain management, leaving patients nowhere to turn. His decision to stop prescribing opioids after Dr. Christensen’s conviction—out of fear that he could be next—shows the chilling effect of aggressive prosecution. And the tragic outcome for his former patients mirrors what has happened nationwide as pain management has been criminalized.

Jeffery A. Singer has a new book out on April 8th: Your Body, Your Health Care.