I have been appreciative of the content and collective wisdom of this forum for a long time. This is my first post.
Considering many patients are not very forthcoming about their prior criminal history on risk assessment forms such as the ORT. I have utilized criminal background checks as a means for risk stratification when deciding to prescribe opioids. I typically use the arrests.org website and screen for drug trafficking charges or pattern of multiple drug/alcohol abuse related arrests (e.g. multiple DUIs). I understand that the website only mentions arrests and not if someone was found guilty for that crime. With that information I ask the patients then, and typically they then admit to the charges. However, my employer is still concerned about the legality to use that website, and doesn't want to be held reliable for accessing someone's criminal records (even though they are public records and are very relevant to my treatment plan with the patient).
Life is never simple. Being a doctor is never simple. You can never reduce med-Mal risk to zero. That's why it's called risk "management" not risk "elimination."
Why don't you ask your employer, which is better,
1-A frivolous, stupid, civil lawsuit that's going to go absolutely nowhere because you did the right thing by recommending non-narcotic treatments to someone with a past history of admitted drug use/abuse/sales, versus,
2-Reckless homicide charges, loss of DEA license and career, AND also the risk of a civil lawsuit for wrongful death when opiates kill because you looked the other way?
Considering choice #1 is basically theoretical (and very defendable and not career ending) and #2 is and has been a reality for many doctors now (not just a "maybe," "could happen," theory by a nervous hospital administrator), is very severe and career ending, I think the choice is pretty clear which is the best choice, but I'll let you decide for yourself.
I think if you stick to legitimate websites of public records from government sites, confirm it with the patient, and do what's in the best interest of the patient, you'll be reducing your legal risk as much as you can. Looking the other way, prescribing to known addicts and dealers because you're worried about some technicality, is not the right thing for the patient, or anybody for that matter, medically, morally or legally. We're not taking about turning off people's ventilator oxygen here. We're talking about a treatment with lots of risks and a less than ideal track record of evidence of even working very well.
But like anything else, you'll have to make your own decision, which makes you more comfortable, and what allows you to sleep easy at night.
Personally, if feel pretty good about getting in front of a jury, and defending a prescription not prescribed to an admitted addict or dealer, regardless of how I got that information, and especially if the patient confirms it. That's infinitely more defendable than trying to explain a prescription written, to an addict or dealer, that led to someone's death, because you were advised to look the other way.
Also, have your legal people go trough this very, very, very long list of DEA actions against doctors:
http://www.deadiversion.usdoj.gov/crim_admin_actions/
Also, read it yourself as we all should. Then have them draft a list of doctors that have had severe consequences or actions against them as a result of NOT writing an opiate RX, that are even remotely close to the loss of license and criminal charges listed here against these doctors for prescribing opiates, in these numbers.
If you find any in the past 10 years, not related to untreated end-of-life pain, please post them here when you find them. Overprescribing, in my humble and little opinion, carries risks greater than under prescribing (though not zero), by a ratio of 1000 to one, in our current practice environment.
You're in the big leagues now. Make a choice and stand by it. No one said it would be easy.