It was the kind of letter Dr. Hurwitz received from people across the country. His office in the Virginia suburbs of Washington was like a Lourdes for people with pain, one of the most widespread health problems. Surveys have found that one in five adults deals with chronic pain, and that it is treated adequately only about half the time.

Image Credit... Wesley Bedrosian

Prescribing opioids was once taboo because of concerns over patients’ becoming addicted. But medical opinion gradually shifted over the past two decades as researchers concluded that high doses of opioids could sometimes be safer and more effective than alternatives like surgery or injections.

Two of the leading pain experts, Dr. Russell K. Portenoy of Beth-Israel Medical Center and Dr. James N. Campbell of Johns Hopkins University, testified without pay as experts for the defense. They said Dr. Hurwitz was widely known as a knowledgeable physician and passionate advocate of giving patients full pain relief, unlike many doctors who were reluctant to prescribe opioids because they feared legal repercussions, particularly when dealing with patients who sometimes used illegal drugs.

Such “problem patients” consumed so much time and energy that most doctors refused to treat them “regardless of what the consequences would be for the patient,” Dr. Campbell testified. He said that he had been initially skeptical of some of Dr. Hurwitz’s high-dose treatments, but was then impressed by the results in patients he sent to Dr. Hurwitz.

He said some doctors might argue that Dr. Hurwitz was guilty in some instances of negligence that would make him liable for damages in a civil case. But Dr. Campbell contradicted the prosecution’s experts by testifying that all the prescriptions were clearly within the “bounds of medical practice.”

That legal phrase is the crucial distinction in this criminal case, which the jury was deliberating as this column went to press: Did Dr. Hurwitz knowingly prescribe drugs to be used for nonmedical purposes? (For updates on the case, see www.nytimes.com/tierneylab.)