The fear of increased regulatory oversight also colors the way a prescriber provides opioid medications for pain. If prescribers has a high fear level, they can be tempted to use less effective medications to treat pain in their patients. Findings from a survey with 963,385 registered physicians found that when adequate documentation exists in the medical records, the risk of action against any physician who prescribes opioids for chronic pain is very small.
What the survey did reveal, however, is that of the large group of physicians cited previously, there were 47 arrests in 2003. In addition, there were 56 DEA revocations from 2003 and 2004. Most of the physicians in the legal actions did not have a primary patient—physician relationship that would merit continued opioid prescribing. Some of the reasons for legal action included:
■ Prescriber substance abuse
■ Loss of medical license
■ Sex in exchange for prescriptions
■ Prescribing without seeing the patient
In another review of press reports of trials or indictments, opioid prescribing offences were tracked from 2004 to 2005. In this group of 47 cases with 53 physicians, 32 of the cases involved the prescribing of opioids to persons outside of legitimate medical practice. Only two of the cases were reviewed by state medical boards before the cases were initiated. These public reports of physician wrongdoing without adequate review can contribute strongly to provider fears of oversight and legal review.
Most states have laws that govern opioid prescribing, and the federal government requires a license to prescribe opioids. These requirements lend themselves to tracking the prescriptive practices of physicians, nurse practitioners, and physician's assistants. When considering the overall picture, it is wise to consider that of all the thousands of physicians practicing and prescribing opioids in the United States in 2002, only 120 were sanctioned by state medical boards and many had multiple violations. The findings of a review of state medical board sanctioning practice found that if the physician had an intact patient—physician relationship and the opioids were documented for treating a painful condition, the risk of formal sanction was very low.
Although pictures of health care providers being taken off to jail or news releases about prescribers being sanctioned for prescription abuse with opioids make headlines and leave a lasting impression, they should always be considered in light of the true findings. Most health care providers follow prescribed rules and regulations for prescribing opioids. If proper documentation accompanies these practices, the risk of legal intervention is seen to be very low.
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