A medical expert testifying in a criminal case against a Kennebunk doctor accused of overprescribing pain medication says the doctor should have sent her patients to a place where they could have received “a higher level of care” once they were addicted to her prescribed medications.

On Thursday, an attorney defending Dr. Merideth Norris asked: What if there was nowhere else for these patients to go?

Norris is on trial in U.S. District Court in Portland. She faces 16 counts of illegal distribution of controlled substances for prescriptions she wrote to five patients in 2021 and 2022. The trial began Monday and is expected to continue into next week.

Prosecutors say Norris was writing life-threatening combinations of opioids, sedatives and stimulants to vulnerable patients in the throes of addiction. They must prove these medications were written outside what’s normal for prescribers and without a legitimate medical purpose.

Her lawyers contend that Norris treated her patients with the best intentions. Norris saw hundreds of patients at her private practice in Kennebunk and several medication assisted treatment centers. Her attorneys said Norris treated patients with “complicated substance use histories,” many of whom had been left behind by other doctors.

On Wednesday, the prosecution’s expert witness, Dr. Timothy E. King, described his impressions of Norris’ five patients to the jury. All had histories of substance use disorder, yet Norris – who is an addiction medicine specialist – prescribed them various kinds of opioids for vague reports of pain, King said.

The opioids did not improve any of the five patients’ problems with pain, King said. In some cases, he said they made matters worse and Norris should have stopped prescribing them.

Norris’ attorney, Amy Fairfield, asked King at one point, while reviewing records for a 35-year-old patient, whether he believed Norris should have stopped treating the patient in general.

The man was on methadone for lower back pain and hip pain, but also had previously struggled with opioid use disorder. He admitted to relapsing with other drugs while he was on methadone.

King suggested that Norris should have referred the patient to a “tertiary care facility,” like a rehab center or university-run program, where he would be surrounded be several experts.

“Where do you find one of those?” asked Fairfield, explaining the lack of options in southern Maine, especially during the COVID pandemic.

King said he didn’t know what options existed in Maine but said it was Norris’ responsibility to know as an addiction specialist.

“I’m sure they are available,” King said. “Maybe not as easily accessible as we would like them … but we can be sure here that harm is being done by the ongoing use of opioids.”

MEDICAL CREDIBILITY

Fairfield’s question echoed points the defense raised on Monday, that Norris worked with many patients who didn’t have anywhere else to go, patients “she couldn’t look away from.”

Of the five patients at the center of her case, one was formerly incarcerated. Another left a clinic because she refused to drug test, King said. Another couldn’t work and was receiving disability benefits.

Norris’ attorneys have questioned the government’s authority to raise such allegations of dangerous prescribing against their client without having her medical expertise and background.

Her attorneys have leaned heavily on an investigation by the Maine Board of Osteopathic Licensure that cleared Norris of wrongdoing.

The board reached its decision days before federal agents raided Norris’ practice and arrested her. An agent with the Drug Enforcement Administration said Tuesday that they didn’t really care about the state board’s investigation because it was smaller and less thorough than their own.

King lends more medical credibility to the government’s case. He is certified in addiction medicine and pain management. He has been in the medical field for nearly 50 years, working as a doctor in the Chicago area and northern Michigan, where he now lives.

He’s taught and testified in many trials for the Department of Justice, some similar to Norris’ prosecution.

He was hired to testify in Norris’ case after another expert for the government, Dr. Shonali Saha, resigned following media coverage.

King testified this week that opioids should be treated as a last resort. He said he only prescribes them when he believes they’ll improve a patient’s quality of life or ability to function, and he doesn’t use high doses. He said there are kinds of pain that opioids don’t work for, including some of the pain reported by the five patients at the center of Norris’ case.

King cited guidance on opioid prescribing from the CDC, first published in 2016.

But Fairfield said Thursday that the CDC updated its guidance in 2022, softening its original recommendations but still recognizing opioids as addictive and potentially life threatening.

“Were the 2016 CDC guidelines too rigid?” she asked.

“No, they were misinterpreted,” King said. “The data was still valid and the recommendations were still appropriate. … Nothing was substituted or negated from the 2016 data.”

PATIENT RECORDS 

Fairfield spent Thursday referring to patient records suggesting Norris did more than give her clients opioids.

This was after King spent all of Wednesday arguing that Norris’ records showed “opioid-centric” treatment with little consideration of other forms of care, including physical therapy and counseling.

Norris recommended exercise and diet improvements, and referenced other providers offering things like therapy, Fairfield pointed out. Norris also wrote about following up with patients after writing her prescriptions.

But King said he was skeptical of these notes. Her records offered little that could help third-party reviewers, including other medical providers who needed to know what Norris had done.

He said nothing in Norris’ patient notes justified her prescriptions. Some of them showed she was aware of especially personal details of her patients’ lives, resembling what someone might expect from a therapist.

For one patient, she commented often on his “toxic” relationship to his mother and a fixation on his ex-girlfriend. Norris knew about his living situations, his efforts to commit to various hobbies.

Fairfield suggested that these notes proved Norris was monitoring her patients’ well-being and any impact her medications were having.

But King didn’t take these observations from Norris seriously, either.

“There’s no truly objective monitoring of his functioning,” he said. “There’s nothing meaningful or objective here that monitors his improvement or worsening of function.”

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