Balance, Uniformity and Fairness
Summary: Effective Strategies
Strategy 1. Distinguishing between criminal behavior and medical negligence. The Roundtable developed a simple, five-step Procedural Template to assist enforcement in assessing a doctor’s behavior and determining when to refer investigations to medical licensure boards for evaluation and when to pursue criminal charges. Use of such a Template in investigations involving the prescribing of pain medications should aid in achieving balanced pain policy.
Strategy 2. Balancing publicity. The undesirable chilling affect from a tiny number of sensationalized media cases on doctors’ prescribing practices has been damaging.
The Roundtable recommends that law enforcement officers follow the guidelines of the Department of Justice Media Relations rules³ and the American Bar Association. To the extent these rules counsel against speaking publicly, that advice is particularly appropriate in the investigating of doctors, given the far-reaching consequences of under-treatment of pain.
Strategy 3. Access to experts. Appropriate treatment of patients suffering from chronic pain as well as critically ill patients is complex. Law enforcement, particularly at the local and state level, often does not have a well-qualified pain medicine expert to consult.
Leading pain societies plan to develop a roster of national experts who agree to be available to law enforcement for informal, “curbside consultation.”
Strategy 4. Technological aids. Electronic prescription monitoring programs (PMPs) can be useful as a quality improvement tool, and can provide important information for doctors in identifying drug-seeking behavior.
PMPs are preferable to now-outdated triplicate prescription forms. PMPs are not a law enforcement tool, however, and should only be available to enforcement as part of the investigation of an active case and only with appropriate procedural safeguards.
Strategy 5. Interagency collaboration. Where legally possible and ethically appropriate, law enforcement, state, local and federal investigators, medical boards, and third-party payers, should share information regarding investigation of a suspect physician.
Physician behavior that arguably falls into a “gray area” between criminal and regulatory, should be deferred to state medical boards for evaluation and corrective action.
Strategy 6. Education. Education on all sides is critical. State medical boards that have not yet done so should study, adopt and promote the Model Policy for the Use of Controlled Substances for the Treatment of Pain developed by the Federation of State Medical Boards. State medical societies and medical-specialty societies should do likewise.
Law enforcement should seek to learn the basics of good pain management for chronic pain sufferers and critically ill patients. And all interested in a balanced pain policy should work to educate the consumer that opioids and other pain medicine are a part of quality medical practice.
Finally, it is critical to educate consumers to make certain that their medicines are secured against diversion that may occur in the home.
