Perils when prescribing controlled drugs

Key Points

There are few more difficult or frustrating patients than those in need of long-term treatment with opiates or other controlled substances. Often the patient presents a very sympathetic picture: in chronic pain, debilitated, and dependent upon you for relief. Equally often, the pain isn't objectively verifiable, meaning you must rely on the patient's history and complaints to gauge his need for pain medication. And because strict regulations prohibit inappropriate or indiscriminate prescribing of controlled substances, treating the congenial patient seeking drugs can jeopardize your license and practice.

It's not uncommon for a physician to first learn that a patient has a history of drug-seeking behavior when the doctor becomes the target of a medical licensing board, DEA, or police investigation. So how can you appropriately care for a patient who claims to be in severe pain? As with most other medical-legal questions, the answer lies mostly with documentation. When treating a patient with controlled substances over an extended period of time, make sure that the record includes:

Another caveat: Don't renew a prescription until enough time has elapsed from when you wrote the prior prescription, in case the patient is misusing the drugs or diverting them to someone else.

Check the rules in your state

Pharmacologists generally advise against the use of schedule II drugs for "detoxification" or "maintenance" purposes, unless the drug regimen is part of a narcotic treatment program. Many states prohibit physicians from engaging in detoxification or maintenance treatment unless they're specifically trained and registered to do so. And be sure to check your state's rules for prescribing amphetamines, sympathomimetic amines, and anabolic steroids.

You're less likely to run afoul of state regulations if you make efforts to wean patients from controlled substances, decrease dosages, and try nonsteroidal anti-inflammatories or other treatment modalities.

The author is a health law attorney with Kern Augustine Conroy & Schoppmann in Bridgewater, NJ, Lake Success, NY, and Philadelphia. He can be reached by e-mail at kern@drlaw.com
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This department deals with questions on common professional liability issues. We cannot, however, offer specific legal advice. If you have a general question or a topic you'd like to see covered here, please send it to Malpractice Consult, Medical Economics, 123 Tice Boulevard, Woodcliff Lake, NJ 07677-7664. You may also fax your question to us at 201-690-5420 or e-mail it to memalp@advanstar.com
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