Pain Relief, Prescription Drugs, and Prosecution: A Four-State Survey of Chief Prosecutors

Author:

Ziegler Stephen J.,Lovrich Nicholas P.

Abstract

The experience of having to suffer debilitating pain is far too common in the United States, and many patients continue to be inadequately treated by their doctors. Although many physicians freely admit that their pain management practices may have been somewhat lacking, many more express concern that the prescribing of heightened levels of opioid analgesics may result in closer regulatory scrutiny, criminal investigation, or even criminal prosecution.Although several researchers have examined the regulatory environment and the threat of sanction or harm it poses to physicians and patients, few have examined the likelihood of investigation or prosecution stemming from the aggressive use of opioids in physician-directed pain management. Accordingly, in an effort to assess whether the fear of prosecution is realistic and, if so, what factors contribute to its likelihood, we surveyed chief prosecutors in four states about their knowledge, opinions, and attitudes concerning opioids and the prosecution of physicians stemming from the treatment of patients who were either terminally ill or suffering from chronic noncancer pain.

Publisher

Cambridge University Press (CUP)

Subject

Health Policy,General Medicine,Issues, ethics and legal aspects

Reference145 articles.

1. 114. Due to variation in the names of offenses among the states, we classified offenses using a generic classification scheme. Moreover, to avoid double counting, we counted only the highest offense when respondents provided lesser included offenses as alternatives (e.g., when both murder and manslaughter were offered, only murder was counted).

2. 84. Meisel, , Jernigan, , and Youngner, , supra note 26.

3. 113. Prosecutor #5: In our jurisdiction we have a significant drug problem, including prescription drug abuse. Most prescription drugs enter the criminal arena via forged prescriptions or sales by a patient. Additionally, a large number of prescription drugs are stolen from disabled and elderly patients and then diverted into the drug world. Prosecutor #6: In our state, there is a problem with the medical [board not] being vigilant enough. They need to be “harder lined.” More severe sanctions, etc., would help with the “pill pushing” (some dole it out like candy). But you could not realistically prosecute most of this, nor would I want to. We don't have the resources nor do the cops. Prosecutor #7: Unless the doctor's conduct is extremely outrageous, I think it is not productive to prosecute doctors. Prosecutor #8: I realize that there is a problem [with health professionals who self-medicate] but also believe with treatment that these persons can be rehabilitated. Also realize that certain types of doctors should prescribe more pain-killers but are afraid to because of [their medical] license. The biggest problem [are patients who abuse the drugs and who are eventually able to find] older doctors (legal suppliers) who need the money. Prosecutor #9: Prescribing drug cases: For profit? [I have no anxiety when deciding to prosecute]. [Doctor has] lax controls? Punish for stupidity or do we want a knowing violation? If the physician is impaired [and diverting, I] would treat [the case] as if [it were motivated by] profit, but would treat differently for sentencing purposes. Evidence issues also present a problem — hired experts on each side would describe typical dosages — result in reasonable doubt? What about witnesses? Credibility issues are present because they may be addicted patients who are now cut off or co-defendants who assisted in street sales. If I get an undercover officer, that would be better, but [that would be] a problem if the jurisdiction is small.

4. 132. See Alpers, , supra note 1; Jesilow, , Pontell, , and Geis, , supra note 21.

5. Disciplinary Actions and Pain Relief: Analysis of the Pain Relief Act

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