'Cavalier' or criminal? Doctor who wrongfully prescribed opioids defends work he 'loved'

Dr. David Suetholz was a pioneer of addiction treatment in Northern Kentucky, among the first to become qualified to treat the condition with medication.

He had a family practice where he saw patients with everyday health concerns but also welcomed those with chronic pain or addiction disorder.

“People with addiction have felt as outcasts,” he said. Not in his office.

Now 74, the family doctor and Kenton County, Kentucky, coroner for 30 years is facing the possibility of spending the rest of his life in prison for work he did at that practice.

He was convicted late last year in U.S. District Court in Covington of 12 counts of illegally prescribing medications, including opioids, to three patients. Suetholz prescribed the medications in high doses and “dangerous combinations” without justification, prosecutors said. A jury agreed, at least partially, saying his treatment of three patients was against the law. He is scheduled to be sentenced in June but has asked Judge David Bunning to grant him a new trial or overturn the convictions.

“Having this occur not only deprived me,” Suetholz told The Cincinnati Enquirer, part of the Paste BN Network, in a recent interview. “I had value to the system that I think was unfortunately taken.”

Working through the opioid epidemic

A longtime coroner in a state hard hit by the opioid crisis, Suetholz witnessed the destruction of individuals and families through every wave of the epidemic – starting with prescription pain pills, through the heroin crisis and into the fentanyl scourge.

He wrote to The Enquirer about the lack of doctors who could or would care for people with substance use disorder.

“The question is, why?” Suetholz wrote in the March 2013 letter to the editor. “The main reason is the inability to want to get involved with a drug addict.”

He saw harm done by a 2012 Kentucky law that cracked down on pill mills and unintentionally drove some addicted people to heroin. He saw trouble in 2016 when the Centers for Disease Control and Prevention put out restrictive prescribing guidelines to curb overprescribing. These guidelines put a chill on some legitimate opioid prescribing and hurt some chronic pain patients who could no longer get pain pill prescriptions.

Now there are newer CDC guidelines, which came out in 2022, following his conviction, that note there is no one-size-fits-all answer to treating pain.

Suetholz said he served his patients as he saw fit through it all – and that includes the patients who were part of the criminal case against him.

“The point was that what they were taking was allowing these individuals to function normally on a daily basis.”

Patients, doctors share views of Suetholz

Suetholz has been characterized by some former patients and doctors as caring, regardless of the weighty federal charges.

“I could tell him anything and I think that’s what you really need with a doctor,” said Margaret Abdelghany, 69, a retired Veterans Administration nurse who saw Suetholz for primary care for 40 years.

“I wouldn’t have gone to him if I didn’t think he was a good doctor,” she said.

Dr. Jeremy Engel of Northern Kentucky, an activist for medical treatment in the early days of the heroin epidemic, saw Suetholz this way: “A traditional, noble doctor caring for patients and addressing a crazy-destructive time.”

Dr. Mina “Mike” Kalfas, among the first certified addiction experts in the region, said Suetholz understood the dangers of addiction − including the risk of undertreating pain.

“He was willing to do whatever he felt his patients needed,” Kalfas said. “That includes pain patients as well as addiction patients – get them what they need and the heck with anyone that disagrees with you.”

Kalfas said Suetholz came from an era when physicians were not "on a leash."

“It may sound cavalier at times − and maybe he was a bit,” Kalfas said. “But those types of docs felt empowered to do what they felt needed to be done and usually weren’t questioned or criticized for it.”

"It was," Kalfas said, "the ends justified the means."

'I cannot morally stop'

One of Suetholz’s earliest transgressions – which had no bearing on the case – came as prescription pain pills were driving overdose deaths in the country.

In 2002, the Kentucky Board of Medical Licensure restricted his license temporarily, barring him from prescribing methadone.

Reminded of the infraction by The Enquirer, Suetholz said he didn’t know then that doctors could not treat patients with methadone for opioid addiction. His reasoning for prescribing it? “She was a prostitute. She was performing her sexual favors for her … addiction.”

Suetholz said the patient told him she’d have to take a bus at 6 a.m. to get to a distant methadone clinic and he thought he could help by giving her a methadone prescription instead.

After he was barred from prescribing, he said, he told colleagues, “I cannot morally stop this medication for this lady.”

“At this time, drug addicts were looked at as low-level, low-life individuals that were basically worthless to society,” Suetholz said.

After his infraction with methadone prescribing, Suetholz took a course to treat opioid addiction patients with Suboxone, which can be prescribed by qualified medical staff and filled at pharmacies.

To this day, methadone treatment for opioid use disorder remains available only in licensed and supervised clinical settings regulated by the U.S. Drug Enforcement Administration. But the treatment style has come under criticism as the opioid epidemic rages on and the death toll continues to be huge.

The clinics are often criticized by treatment advocates as degrading and hard to square with a patient’s daily life – and easier access could save lives.

Feds: Suetholz ignored warnings

In the criminal case against Suetholz, which began with his October 2021 indictment, federal investigators said Suetholz was illegally prescribing medications, including oxycodone and pharmaceutical fentanyl, to five patients from September 2018 to August 2021. 

The month before his criminal charges were filed, court records show, more than a dozen federal agents, wearing tactical gear and carrying firearms, raided Suetholz's office while he was seeing a patient.

Among the more specific claims levied against Suetholz, prosecutors said he: 

• Ignored patients’ failed drug tests. 
• Disregarded evidence about patients' addiction being escalated. 
• Didn't consider other evidence that would have raised red flags about the “appropriateness” of the prescriptions he wrote. 

“This is a case about warnings that were ignored,” federal trial attorney Dermot Lynch said during the trial's closing arguments, citing a second infraction with the licensure board. 

In 2012, Suetholz was temporarily prohibited from prescribing certain medications after an investigation found some of his patients received early refills of oxycodone, Xanax and Valium. Several patients were filling their prescriptions at multiple pharmacies and pill counts were not being monitored.

Suetholz did not address reports of his patients trying to get early refills and selling or stealing pills, investigators found.

He has insisted through his lawyers that he was only caring for his patients. His office staff and he worked to prevent patients from taking advantage of the practice, Suetholz said.

The state medical board revoked his license to practice medicine following his conviction.

Suetholz said he treated 'outcasts,' 'people on the fringe'

Suetholz is proud that he took care of people who were considered “outcasts.”

“I have always dealt with people on the fringe of society,” he said. “They don’t always think in the logical manner. You have to accept the socioeconomic (issues) and mental status that they deal with.”

His conviction and uncertain future put an end to all of that.

“I truly loved my job,” Suetholz said. “I gave value to my patients. And they were all well aware of that.”