Medical boards fear aggressive prosecution

A majority of state medical board members recognizes that prolonged opioid prescribing for chronic cancer and noncancer pain is legitimate, but they believe that prosecutions of doctors for overprescribing pain medications are on the rise, according to a survey by the American Pain Society, Glenview, Ill.

Data shows that there has been considerable improvement since the early 1990s in overall understanding of pain management issues, particularly the legality of prescribing opioids for chronic noncancer pain and in knowing correct symptoms of addiction. Still, only two in three respondents say they believe prescribing opioids for chronic noncancer pain is lawful and generally acceptable medical practice.

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Sixty-nine percent of those surveyed perceive drug addiction in both behavioral and physiological terms, but the respondents did show better understanding of what constitutes addiction compared with previous survey findings. Despite increased awareness that addiction is a behavioral condition, nearly one in five respondents say they consider addiction as only a physiological phenomenon.

"These results may be due to the history of confusing terms and definitions that has influenced the belief of many in the health care field," the report states. "These findings point to a need to continue educating health care professionals and regulators about what does and does not constitute addiction."

The study recommends that medical regulators must understand the differences among addiction, physical dependence, and tolerance in patients with pain because such misconceptions can influence disciplinary determinations adversely.

With regard to the increasing presence of law enforcement in medical practice, some 35% of medical regulators believe law enforcement is becoming more involved in the investigation and prosecution of physicians for opioid prescribing practices. The authors note it was not clear whether the board members approve of increased criminal sanctions against physicians.

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COPYRIGHT 2008 Gale, Cengage Learning