BAKERSFIELD, Calif. _ The police report is all David Cole Lang's family has to describe his last moments on Earth.
Fifty pages of officer narratives and witness interviews filled with grisly detail, it lacks any explanation for his death. Ten months later, Lang's widow, Monique, says she still has no clue as to why the 33-year-old combat veteran and father who struggled with opioid addiction ended up fatally shot by a doctor whom _ as far as Monique knew _ he hadn't seen in over a year.
"I didn't understand why he was there," she said. "I still don't."
On that April evening last year, according to interviews in the report, Lang yelled and cussed at the addiction and pain treatment doctor, Edwin Zong, in his office, and leapt across a desk to punch him repeatedly. Hearing the doctor scream for help, the last patient waiting to see Zong that day ran to open the door. He told police he found Lang standing over Zong, curled in a fetal position on the floor, his face covered in blood and "the fear of a child in his eyes."
"Hey!" the patient yelled.
When Lang turned toward the doorway, Zong told police, the doctor opened a desk drawer and grabbed a handgun. He fired three or four times. One bullet tore through the blood vessels in Lang's neck. He staggered outside, collapsed in a parking lot and died.
Local authorities concluded that Zong had acted in self-defense, and he faced no charges. In an email to Kaiser Health News, the doctor declined a request for an interview but said he believes he was targeted for robbery. "I was lucky I wasn't killed," he wrote. "Treating addiction is a very tough job, many doctors won't do it."
The tragedy that played out in Zong's office speaks to a dangerous trend: In many parts of the United States, the number of people addicted to opioids far exceeds the capacity of doctors willing and authorized to treat them. That is particularly true when it comes to professionals like Zong who dispense Suboxone or Subutex, both formulations of buprenorphine _ widely considered the optimal addiction treatment because it all but erases opioid withdrawal symptoms without creating a significant high.
With tens of thousands of Americans dying annually from opioid overdoses, the Food and Drug Administration recently signaled that it is open to expanding the number of drugs available to ease withdrawal and reduce cravings, but access to prescribers remains a problem even for the drugs that already exist.
One reason for the shortage of providers is that doctors must take eight hours of training to prescribe the medication and apply for a waiver from the federal Drug Enforcement Administration, because the medicine is itself an opiate. Few doctors are willing to check all those boxes and take on the sometimes difficult patients who seek the drug.
Patients addicted to heroin or prescription opioids like oxycodone or fentanyl suffer severe withdrawal _ sweats, tremors, anxiety _ and are often desperate for medication-based treatment to wean them from the drugs or at least quell their symptoms. For the cash-strapped patients, the cheaper the better.
Doctors who accept these patients, whether motivated by profit or compassion, can become overwhelmed, seeing far more than their offices can handle, opening the door to chaos and lawlessness. More problematic is that some clinics, like Zong's, offer a mix of services _ treatment for both opiate addiction and pain. Patients being prescribed potentially dangerous narcotics are mixed in the waiting area with those struggling to kick addiction.
Several years ago in Vermont, which pioneered buprenorphine treatment, some small practices rapidly swelled to 600 or 700 patients each, said Dr. Richard Rawson, an experienced addiction researcher at the University of Vermont. Doctors sometimes prescribed more than their authorized limit, failed to test patients for drug abuse and _ wittingly or not _ fostered illegal sales, Rawson said.
"We know that when you have those types of practices where you bring large numbers of addicted individuals together it produces a mess," he said. "People are selling drugs in the parking lot and all kinds of wacky stuff like that."
Inevitably, some patients relapse. Some become angry if they don't get what they came for. A solo practitioner like Zong _ who by many accounts had few employees, a tendency to work late on his own and a high cash intake _ faces security risks.
Zong was concerned enough to stow a gun in his desk drawer. "I keep a gun in my office for self-protection," he said in his email.
