As any doctor or nurse practitioner that treats patients with pain issues is aware, prescribing opioids has become a risky proposition. Ever since the Centers for Disease Control and Prevention (“CDC”) released its “Guidelines for Prescribing Opioids for Chronic Pain” in 2016, both Federal and State criminal investigators have targeted doctors who prescribe opioids to patients with chronic pain issues. Many primary care doctors as well as pain management specialists have had their patient files subpoenaed and scrutinized by both local and federal investigators. Criminal investigators are also monitoring medical board proceedings that relate to claims of “over-prescribing” opioids. Unfortunately, what this often leads to is “Monday morning quarterbacking” of difficult medical decisions which can result in the filing of civil criminal charges. Much to their shock and dismay, doctors and nurse practitioners are now finding themselves defending their medical judgements (and record-keeping habits) in civil and criminal cases where they stand accused of either state or federal drug trafficking charges. More frightening, in the event of an accidental overdose, the health professional may be charged with murder.
Not surprisingly, as a result of the enforcement risks associated with opioids, many doctors have simply stopped treating patients with chronic pain issues or prescribing opioids to any of their patients. This has been a painful and unintended result of the guideline. As one of the authors of the 2016 CDC Guidelines recently commented, “Unfortunately, some policies and procedures purportedly derived from the guideline have in fact been inconsistent with, and often go beyond, its recommendations.” See Full Comments Here. This includes often unfounded criminal prosecutions of dedicated medical professionals who are the last resort for the “worst of the worst” patients.
In recognition of the harm that was being caused by the complete cessation of opioids to patients who had been successfully treating their pain with opioid treatment, the HHS recently published a guide discussing the dangers of rapidly tapering or precipitously ending opioid prescriptions and the complexities of successfully tapering opioid prescription levels. See Guide for Dosage Reduction or Discontinuation.
For those doctors or nurse practitioners who find themselves in the crosshairs of a criminal prosecution for alleged over-prescribing or failure to properly taper dosages for patients, this is a very helpful resource. When faced with an over-zealous prosecutor, you need all the help you can get in convincing him or her that you are not contributing to the “opioid crisis.”
No one can argue with the fact that opioid addiction is a grave problem which must be addressed. However, forcing well-meaning and dedicated health care professionals to cut-off honest patients from a solution to their chronic pain issues (often leading them to the dangers of finding a solution to their pain problems on the streets from illicit sources) exacerbates the problem. It is a good sign that some government agencies are beginning to realize this fact.
John J. Rice is former federal prosecutor who specializes in representing professionals who are being investigated and prosecuted for alleged criminal behavior. He defends professionals that are fighting for both their careers and their freedom.