No One Prescribing Opioids for Non-Malignant Pain is Safe

[Aether2000]

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You cannot control how they take the meds, but you will be held responsible if they overdose and die or sometimes OD and end up in a hospital. You can be held responsible if they mix alcohol plus opioids or if you prescribe opioids to those that are taking benzodiazepines. You can be held responsible for deaths ostensibly caused by opioids that occurred a decade earlier. You can be held responsible for patient deaths by imprisonment, loss of license, loss of livelihood, loss of assets that are confiscated by the government. You can be held responsible for high numbers of pills being prescribed or high MED amounts being prescribed. You can be sued for wrongful death or for causing addiction. You can be sued by third parties injured by your patients being prescribed opioids. Frankly it is open season on doctors prescribing opioids for chronic non-malignant pain.

Guys, it is just not worth the risk. Google "doctors arrested opioids" and you will find pages and pages of listings of doctors that have gone down, not all for being bad doctors. The DEA has so many of these that they have a website to discover physicians with registration revocations (Cases Against Doctors) and state medical boards have engaged in several times the number of actions compared to the DEA for opioid prescribing issues.

 

[drusso]

You cannot control how they take the meds, but you will be held responsible if they overdose and die or sometimes OD and end up in a hospital. You can be held responsible if they mix alcohol plus opioids or if you prescribe opioids to those that are taking benzodiazepines. You can be held responsible for deaths ostensibly caused by opioids that occurred a decade earlier. You can be held responsible for patient deaths by imprisonment, loss of license, loss of livelihood, loss of assets that are confiscated by the government. You can be held responsible for high numbers of pills being prescribed or high MED amounts being prescribed. You can be sued for wrongful death or for causing addiction. You can be sued by third parties injured by your patients being prescribed opioids. Frankly it is open season on doctors prescribing opioids for chronic non-malignant pain.

Guys, it is just not worth the risk. Google "doctors arrested opioids" and you will find pages and pages of listings of doctors that have gone down, not all for being bad doctors. The DEA has so many of these that they have a website to discover physicians with registration revocations (Cases Against Doctors) and state medical boards have engaged in several times the number of actions compared to the DEA for opioid prescribing issues.

It's extremely busy on the medico-legal defense side (I only do defense) the last 5 years. So far, defended 3 falsely accused MD/DO's in 3 accidental OD's. All standard of care. All exonerated at jury trials. The emotional and psychological strain on the defendant doctors is consistent with Moral Injury. One retired early because of the experience. One is only doing injections and no med management. Recognize from soup to nuts, the whole process is going to be 5-8 years of your life and cost your med-mal carrier $100's of thousands of dollars. No tort reform in sight. There are good people out there who will defend legitimate doctors. But, it won't come cheap.

 

[hyperalgesia]

This one guy in my city has a lot of opioids in his practice and also dispenses the meds. Pts fill out a mound of paperwork to get accepted as a pt. I know of many pts who "fire" him or who are fired by him because they can't get their inappropriate meds or have aberrations or something else amiss. So I think he does everything "by the book". Still, I feel like it's a dangerous line to walk.

 

[painfree23]

It's extremely busy on the medico-legal defense side (I only do defense) the last 5 years. So far, defended 3 falsely accused MD/DO's in 3 accidental OD's. All standard of care. All exonerated at jury trials. The emotional and psychological strain on the defendant doctors is consistent with Moral Injury. One retired early because of the experience. One is only doing injections and no med management. Recognize from soup to nuts, the whole process is going to be 5-8 years of your life and cost your med-mal carrier $100's of thousands of dollars. No tort reform in sight. There are good people out there who will defend legitimate doctors. But, it won't come cheap.

I’m happy to defend these docs, how do we get that gig

 

[LebronManning]

and also dispenses the meds

docs can dispense meds?

 

[hyperalgesia]

docs can dispense meds?

In some states like mine, yes. It's just another box you check when renewing your license.

 

[emd123]

You cannot control how they take the meds, but you will be held responsible if they overdose and die or sometimes OD and end up in a hospital. You can be held responsible if they mix alcohol plus opioids or if you prescribe opioids to those that are taking benzodiazepines. You can be held responsible for deaths ostensibly caused by opioids that occurred a decade earlier. You can be held responsible for patient deaths by imprisonment, loss of license, loss of livelihood, loss of assets that are confiscated by the government. You can be held responsible for high numbers of pills being prescribed or high MED amounts being prescribed. You can be sued for wrongful death or for causing addiction. You can be sued by third parties injured by your patients being prescribed opioids. Frankly it is open season on doctors prescribing opioids for chronic non-malignant pain.

Guys, it is just not worth the risk. Google "doctors arrested opioids" and you will find pages and pages of listings of doctors that have gone down, not all for being bad doctors. The DEA has so many of these that they have a website to discover physicians with registration revocations (Cases Against Doctors) and state medical boards have engaged in several times the number of actions compared to the DEA for opioid prescribing issues.

I’ve read through many of these cases. They seem most (all?) cases where people were doing egregious things nowhere near standard or reasonable care. That being said, how do you recommend best transitioning to a totally non-opiate practice?

Gradually taper patients to from 90 MED, to 60, to 40, to 0?

Quit job and look for an injection only practice?

Market yourself anew, covering more territory as ‘a Non Opiate Pain’ MD?

Change specialties?

Difficulties to expect?

Barriers?

How to get there?

 

[willabeast]

Life is easier if you do not prescribe class 2 meds. You might consider changing your DEA license to limiting oneself to class 3,4,5 meds. Sort of radical, but it makes the discussions much shorter. Any sort of lawsuit is bad for your health, not just medical ones. Bet if they did a study they would find each malpractice suit is the same as smoking 500 packs of cigarettes. Just sayin.

 

[drusso]

Opioid painkiller fears: Has the pendulum swung too far?

"He became more reclusive two years ago, when his doctor lowered his doses of morphine and hydrocodone. He once took five medications and now takes a dozen, including prescription strength acetaminophen and ibuprofen, a muscle relaxant, an anti-seizure drug and two antidepressants.

“I don’t remember signing up to be a lab rat,” he said.

His six drum sets have gathered dust in his basement since the changes in medication. He rarely drives his 2014 Dodge Ram. He spends most of his days playing video games and watching TV."

 

[ziggyziggy]

It's extremely busy on the medico-legal defense side (I only do defense) the last 5 years. So far, defended 3 falsely accused MD/DO's in 3 accidental OD's. All standard of care. All exonerated at jury trials. The emotional and psychological strain on the defendant doctors is consistent with Moral Injury. One retired early because of the experience. One is only doing injections and no med management. Recognize from soup to nuts, the whole process is going to be 5-8 years of your life and cost your med-mal carrier $100's of thousands of dollars. No tort reform in sight. There are good people out there who will defend legitimate doctors. But, it won't come cheap.

You can get sued/malpractice for other things but atleast they are not assoc. with character assassination/criminal charges/prison time.