I have written extensively about opioids and their impact on our society. There is a list of those posts in Could it Get Worse (June 2026). I count at least 50 posts on overdose and opioid abuse. It is not a new problem, nor even news anymore. And certainly, attention has brought progress.
In 2025, according to the CDC, there were only 69,973 overdose deaths in America. Only. That is a 14% decrease "from the 81,313 deaths estimated in 2024." Sure, progress is positive. But 69,973 is still more each year than the aggregate deaths in the decades of the Vietnam "police action." And we are well over 1 million overdose deaths in the 21st century, according to the State Health Access Data Center.
Imagine the impact. On people, families, and communities. It is as outrageous as it is tragic. And it is ongoing across the country every day.
The thoughts came again when Joan Rubinger was in the news in 2026. She is an athlete who suffered a debilitating injury and rebuilt her life as "an influential pain-relief specialist." She focused on "top-tier athletes" and their "acute and chronic injuries."
In August 2026, according to the Associated Press, the Drug Enforcement Agency alleged that Ms. Rubinger "doled out thousands of illegal prescriptions for highly addictive painkillers." They estimate that over four years, this totalled about 260,000 pills distributed "in more than 20 states."
She agreed to pay a civil settlement of $1.4 million for allegations surrounding her dispensing of "oxycodone, Percocet, and Xanax on hundreds of occasions without any legitimate medical purpose." Despite allegations that she "violat(ed) federal drug statutes and regulations 900 times," there were no criminal charges filed.
The U.S. News reported that federal prosecutors have declined to explain why no criminal charges have been filed. The allegations of her behavior, her "rules," and the specifics of avoiding detection are also detailed in that reporting.
In the end, the DEA pursuit likely comes down to the "tip" from a pro football player's wife. The AP says that Carolina Panthers linebacker Thomas Davis' wife "alerted the agency to the nurse practitioner's activities."
The Justice Department described Ms. Rubinger's practice as "unorthodox." She allegedly "operated out of hotel rooms," kept few, if any, medical records, and worked without physician supervision. Nonetheless, the DEA says she "registered her practice" in a California orthopedic surgeon's office.
That doctor claims to have had no role in the prescriptions or in supervising the nurse. And it appears that "many states ... require nurse practitioners in most circumstances to work under a physician’s supervision when prescribing opioids." Nonetheless, nurses in many states operate without any "legally mandated physician supervision and collaboration requirements."
With a California practice, the AP story is silent on how she managed to prescribe 260,000 pills over a period of years without someone noticing that incongruity. It is unclear whether she is licensed in one of the many states that grant full prescription autonomy to nurses.
In all, it is a cautionary tale. Certainly, we are desperately short of physicians. Physician Shortage (July 2025). They are extending care in many settings. Emergency, Acute, Urgent, and Routine (March 2026). But is there sufficient basis for allowing nurses unsupervised access to prescription pads that pass dangerous substances into the hands of patients and even "street gangs?"
Meanwhile, some will wonder how many pills one would have to prescribe in order to attract the attention of criminal prosecutors.
