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http://www.medscape.com/viewarticle/714023?

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Question

Why are doctors the target of our country's war on drugs?

Response from Aaron M. Gilson, MS, MSSW, PhD


Senior Scientist, Paul P. Carbone Comprehensive Cancer Center, University of
Wisconsin School of Medicine and Public Health, Madison

This question addresses the prevalent perception that physicians, who frequently
prescribe controlled substances (including opioid analgesics) for pain management
and other chronic conditions, are targets not only of investigation and discipline from
their professional regulatory bodies (ie, medical examining boards) but also of local,
state, or federal law enforcement agencies. In particular, the US Drug Enforcement
Administration (DEA) has received considerable attention from the public and
professional media for its actions against physicians. To be sure, the DEA has the
statutory authority to investigate and criminally prosecute violations of federal drug
control laws by physicians who are registered to use controlled substances for
medical purposes. However, it is aphoristic that learning of a physician's arrest
because of his or her "prescribing practices" can have a chilling effect over the entire
healthcare community, regardless of the specific characteristics or ultimate
disposition of the case. Practitioners have expressed such concerns about law
enforcement actions since the 1980s.[1-3] These very apprehensions motivated some
state lawmakers to amend Intractable Pain Treatment Acts, which were originally
created to protect from regulatory discipline those practitioners who prescribe
controlled substances to treat pain, to extend that immunity to criminal
prosecutions.[4]

Research suggests that both administrative sanctions and criminal charges against
physicians for prescribing opioids are infrequent events.[5,6] In fact, a comprehensive
review of cases occurring between 1998 and 2006 showed that 752 individual
physicians (or 0.1% of active "patient care physicians") had faced criminal charges
or administrative reviews, or both, because of opioid prescribing issues. [7] Despite
the seemingly uncommon occurrence of physician prosecutions, DEA criminal
investigations of controlled substances violations were found to increase almost 16%
during the last 2 years of available data (ie, 2005 and 2006), whereas the number of
state medical board cases actually decreased 22% over the same period. In
addition, a recent survey of state medical regulatory board members showed that
35% believed that law enforcement agencies at the national level are increasingly
investigating and prosecuting physicians for violations involving opioids, and another
33% thought that law enforcement had become more involved at the state level. [8]

Overall, law enforcement prosecutions of physicians seem to be a relatively rare


event, but even the act of investigation can suggest a significant risk for formal DEA
action. At the same time, medical regulators perceive law enforcement as
increasingly involved in prescribing cases, which further contributes to the view that
physicians who prescribe controlled substances are likely casualties of the US "War
on Drugs." These issues converge to create an environment in which physicians
often feel threatened when considering whether to provide pharmacologic treatment,
which is legitimate medical practice -- this chilling effect often creates an
unwillingness to prescribe and can result in inadequate pain control. Discord among
law enforcement members, regulators, and healthcare professionals is an untenable
situation, with a direct and deleterious consequence for patients with chronic severe
pain. For its part, law enforcement can anticipate the impact of its activities to avoid
encroaching on the practice of medicine and also to prevent actions that send
intimidating messages to clinicians. Such an approach can serve to enhance the
acceptability of opioid therapy for the physicians who prescribe and the patients who
use these important medications.

References

1. Angarola RT, Wray SD. Legal impediments to cancer pain treatment. In:
Hill CS Jr, Fields WS, eds. Advances in Pain Research and Therapy. Vol
11. New York, NY: Raven Press; 1989:213-231.
2. Brody R. Is the DEA on your case? Am Drug. 1991;June:37-45.
3. New York State Public Health Council. Breaking Down the Barriers to
Effective Pain Management: Recommendations to Improve the
Assessment and Treatment of Pain in New York State. Albany, NY: New
York State Department of Health; 1998.
4. Pain & Policy Studies Group. Achieving Balance in Federal and State Pain
Policy: A Guide to Evaluation. 5th ed. Madison, Wis: University of
Wisconsin Paul P. Carbone Comprehensive Cancer Center; 2008.
5. Jung B, Reidenberg MM. The risk of action by the Drug Enforcement
Administration against physicians prescribing opioids for pain. Pain Med.
2006;7:353-357. Abstract
6. Richard J, Reidenberg M. The risk of disciplinary action by state medical
boards against physicians prescribing opioids. J Pain Symptom Manage.
2005;29:206-212. Abstract
7. Goldenbaum DM, Christopher M, Gallagher RM, et al. Physicians charged
with opioid analgesic-prescribing offenses. Pain Med. 2008;9:737-751.
Abstract
8. Gilson AM, Maurer MA, Joranson DE. State medical board members'
beliefs about pain, addiction, and diversion and abuse: a changing
regulatory environment. J Pain. 2007;8:682-691. Abstract
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Lindon & Lindon, LLC
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Publication of this document does not necessarily mean that the pharmacist or other
person mentioned in the document did what he/she is being accused of.