Adhere to Guidelines When Prescribing Opioids

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EXPERT OPINION FROM THE ANNUAL MEETING OF THE AMERICAN ACADEMY OF PSYCHIATRY AND THE LAW

BOSTON - The line between proper prescribing of opioids and pill pushing is thin and easily crossed, forensic psychiatrists said at the meeting.

The U.S. Supreme Court in 1975 ruled that physicians who are licensed by the Drug Enforcement Administration (DEA) to prescribe narcotics such as extended-release oxycodone (OxyContin) under the federal controlled substances act are liable to prosecution "when their activities fall outside the usual course of professional practice."

But the decision about what constitutes deviation from normal professional practice might fall to the judicial system, and several high-profile cases of doctors being convicted as drug pushers have made many practitioners who would otherwise consider prescribing opioids leery of the drugs, said Dr. Gregory G. Sokolov, of the division of psychiatry and the law in the department of psychiatry at the University of California, Davis.

"There is a role for opiate medications, and there is a role for OxyContin for severe pain," Dr. Sokolov said. "Some of these cases have really scared people away from treating pain patients and prescribing opiates, and although there are going to be people who are troubled and problematic, there are patients who truly benefit from these medications."

Chronic opioid therapy is more commonly used for control of severe cancer-related pain, but appropriate noncancer uses exist for such agents; the trick is knowing which patients will benefit, and which are malingering, said Dr. Ajay D. Wasan from the departments of psychiatry anesthesiology and perioperative and pain medicine at Brigham and Women's Hospital in Boston.

Dr. Sokolov discussed the case of United States vs. Ronald A. McIver, D.O. Dr. McIver, who ran a pain therapy center in Greenwood, S.C., was convicted in federal court of one count of conspiracy to distribute controlled substances and eight counts of distribution, after the death of a patient with high postmortem doses of opiates in his bloodstream.

Dr. McIver is currently serving sentences of 20 years in federal prison for distribution, and 30 years for dispensing drugs that resulted in the patient's death. His appeals, including one made to the U.S. Supreme Court, have been rejected.

Forensic psychiatrists might be called upon to provide expert opinion in criminal cases asking whether a prescribing physician is guilty of illegally prescribing opioids for distribution or abuse, in civil actions such as malpractice cases, and in medical board investigations, including allegations of physician impairment from opioid abuse, Dr. …