Diversion Of Prescription Drugs Undertreatment Of Pain

Main Category: Pain / Anesthetics
Article Date: 20 Feb 2009 - 4:00 PDT

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Diversion of prescription pain medicine from legitimate healthcare channels is a serious, and a growing, healthcare problem in this country. Under-treatment of pain is likewise a serious national healthcare problem.

Today, members of the national law enforcement, medical and bioethics communities come together to release a policy brief aimed at "balancing" these sometimes competing societal concerns.

"The under-treatment of pain is due in part to a kind of undesirable 'chilling effect,'" writes Bill Colby, JD, Senior Fellow for Law and Patient Rights at the Center for Practical Bioethics and primary author of the policy brief. "The concept of a chilling effect, generally, is a useful law enforcement tool," Colby says, but "a chilling effect on the appropriate use of pain medicine is not a public good."

Balance, Uniformity and Fairness: Effective Strategies for Law Enforcement for Investigating and Prosecuting the Diversion of Prescription Pain Medications While Protecting Appropriate Medical Practice suggests several key strategies to aid law enforcement faced with the complicated case of a doctor suspected of illegal conduct related to prescription drugs.

First, the brief provides a step-by-step template to help identify when behavior is potentially criminal. Drew Edmondson, the Attorney General of Oklahoma and a leader in this effort drafted early versions of the template.

"It is imperative that doctors are free to prescribe pain medication to patients who need it to control their pain," Edmondson said. "What we are finding, however, is that doctors feel hindered by the perception that they may be prosecuted for regularly prescribing certain medications. "By creating a clear set of strategies to help guide investigation and prosecution, we hope to help put that perception to rest."

Second, it advocates for the need to carefully balance any publicity, acknowledging that the chilling effect on appropriate use of pain medicine is not a good outcome.

And third, it will provide law enforcement with access to a roster of national experts in pain medicine to help understand this complicated area of medical practice.

William Sorrell Attorney General of Vermont, was another leader of the effort. Gen. Sorrell believes the brief can be a significant aid to law enforcement. "We in law enforcement do not want to be second guessing competent medical professionals or going on witch hunts into medical files," Sorrell said.

His sentiments were echoed by Lisa Robin from the Federation of State Medical Boards. "This policy brief outlines how to achieve an appropriate balance between state medical boards and law enforcement in addressing issues of pain management and diversion," Robin said.

The policy brief is a product of the Law Enforcement Roundtable of the Balanced Pain Policy Initiative, a collaborative effort of the Center for Practical Bioethics, the National Association of Attorneys General, and the Federation of State Medical Boards. The meetings to draft the brief were funded in part by grants from the United Health Foundation and the National Association of Attorneys General Foundation.

Links:

- Balance, Uniformity and Fairness: Effective Strategies for Law Enforcement for Investigating and Prosecuting the Diversion of Prescription Pain Medications While Protecting Appropriate Medical Practice (pdf)
- Effective Strategies Summary - Balance, Uniformity and Fairness
- Law Enforcement Roundtable Attendees , September 22, 2008
- Few physicians actually tried or sanctioned for improperly prescribing pain medications, research in Pain Medicine, September 9, 2008

Center for Practical Bioethics

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