BOSTON — A former Massachusetts doctor was alternately portrayed as a reckless prescriber of powerful, addictive drugs and a compassionate caregiver who tried to help people suffering from chronic pain, as his federal trial began Tuesday.

Dr. Joseph Zolot and his former nurse practitioner, Lisa Pliner, are charged with conspiracy and drug trafficking for allegedly distributing methadone, oxycodone and fentanyl without legitimate medical reasons.

Prosecutors originally charged Zolot and Pliner with distributing drugs that caused the deaths of six patients, but they scaled back the charges after the Supreme Court earlier this year established stricter standards for proving that a dealer’s drugs cause a death. The high court’s ruling requires prosecutors to show that the drugs were the only cause of death.

In opening statements Tuesday, Assistant U.S. Attorney Eric Christofferson did not argue that Zolot and Pliner are legally responsible for the deaths but said they ignored evidence that some of their patients were misusing, abusing and even selling drugs they prescribed for them.

Christofferson also mentioned each of the six patients who died by name and said they continued to get prescriptions from Zolot and Pliner despite indicators the drugs were being abused.

“The defendants ignored these warning signs and provided prescriptions for highly dangerous drugs for people who were abusing or diverting them, time after time after time,” Christofferson said.

During their opening statements, lawyers for Zolt and Pliner vehemently denied the charges and described them as caring healthcare providers who tried their best to bring some relief to patients who suffered from intense pain.

Zolot’s lawyer, Howard Cooper, said Zolot used his best medical judgment to treat thousands of patients with complex pain management issues and took numerous steps to look for signs of abuse, including ordering medical tests to determine whether his patients had legitimate injuries and requiring his patients to submit to random urine tests.

“The evidence will be that Dr. Zolot wrote each prescription in good faith, based upon a professional medical judgment,” Cooper said.

He acknowledged that Zolot “didn’t always do things perfectly,” but said he was “ethically obligated” to listen to his patients and believe what they told him.

“Doctors are not police officers. They are not detectives. They are not DEA agents,” Cooper said.

Pliner’s lawyer, Michael Connolly, told the jury that Pliner cared about her patients, but was sometimes “unwittingly deceived” into writing prescriptions for people who were abusing drugs. He also said Pliner relied on Zolot’s judgment and worked with many patients to reduce the dosage of drugs they were taking.

“Lisa Pliner tried every day when she went to work to do the right thing,” Connolly said.

The first witness called by prosecutors was Joseph Dillon, the brother of Dennis Dillon, one of the patients who died.

Joseph Dillon, who was also a patient of Zolot, said he told Zolot about a week before his brother’s death that his brother was addicted to the painkillers he prescribed and that his health was in danger. After he found his brother dead in the family’s Boston home, he said he confronted Zolot in his office and told him his brother had died.

“He just looked at me with a frown or a smirk on his face and said, ”˜Your brother had problems anyway,’” Dillon said.

During cross-examination by Zolot’s lawyer, Dillon acknowledged that he did not know details of his brother’s treatment by Zolot, including that Zolot had ordered MRIs and other medical tests.

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