PAINKILLER LAW: HAVE YOUR EAR TO THE TRAIN TRACK, AND KNOW WHAT’S COMING.

Comedian Chris Rock has a great bit about why we should all be vigilant for evidence of prejudice or bigotry. As he puts it, when illegal aliens are targeted, “I start listening, because I know blacks and Jews are next.” Then he looks at his watch and adds, “That train’s never late!” This lesson of vigilance is extra important today for all medical providers who prescribe opioids for chronic pain.

For months now, law enforcement has been leading the charge against so-called corrupt doctors and others who prescribe what are viewed as excessive amounts of opioids. In my view, as you know from previous PAINKILLER LAW blog posts, law enforcement’s leadership in this area amounts to putting the cart before the horse: Cops should not be telling doctors how to treat patients. But very recently there has been a slew of crucial developments that sends an unmistakable signal to prescribers, to the risk managers who help insure them, and to the malpractice defense attorneys who defend them. Attention must be paid, or prescribers will get in trouble, risk managers will write a lot more checks, and malpractice attorneys will not prevail using old arguments. And, of course, patients could be unsafe.

To have your ear to the train tracks on this issue is to know that now the scientific evidence is starting to match law enforcement thinking. This means a provider who does not keep up with scientific advances, and information provided by a source other than the pharmaceutical industry, risks getting run over by the oncoming locomotive of opioid reform.

Consider developments from just the past two weeks:

-The Centers for Disease Control’s director declares that too many doctors are prescribing too many opioids for too many people, with deadly impact and little patient improvement.

-The American Medical Association’s new recommendations on opioid prescribing acknowledge the CDC’s position and urge a significant shift in direction by opioid prescribers.

-A Harvard Medical School study finds it inconclusive that opioids are effective in the treatment of chronic pain.

These statements and studies have profound implications: If you as an opioid prescriber practiced in a way that even six months ago was roughly in compliance with the state of scientific knowledge, it would be harder to pin a crime on you if something went terribly wrong with a patient. But now, in the face of evidence from leading scientific and medical authorities which up-ends previous thinking about opioids for chronic pain, a practitioner who doesn’t adjust and adapt and possibly wholesale reform his or her methods of practice is putting themselves on a perilous path. It’s time for opioid prescribers nationwide to shift their practice methods to reflect and incorporate the CDC’s and AMA’s statement and recommendations. To ignore the advancing science is to invite law enforcement scrutiny, and deny yourself the chance to say, “As soon as the science changed, so did I.” Don’t get hit by an oncoming train.

info@painkillerlaw.com MEISTER LAW OFFICES 213.293.3737

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PAINKILLER LAW: FDA and I Call For Abuse-Deterrent Drug Agents

The FDA today called upon pharmaceutical researchers to develop formulations of opioids that would bring pain relief while reducing the possibility of addiction. The FDA refers to “abuse-deterrent” drug agents in the chemical sense. I join the FDA in calling for abuse-deterrent drug agents, only the kind of agents I’m talking about wear badges, drive fast in unmarked cars, and show up heavily armed.

The FDA should be commended for its balanced approach, in which it seeks both the development of less addictive drugs, and the need to get real pain relief to patients. What concerns me is that in investigating healthcare providers who write Schedule II-V prescriptions, typically law enforcement agents including the DEA and state Medical Boards emphasize “case clearing” over balance, hard and fast over nuance, and black and white over shades of gray. Whereas the FDA’s January 9 statement expresses its extreme concern “about the inappropriate use of prescription opioids,” the FDA doesn’t define “inappropriate.” Left to the determination of the DEA, which has been accused of being late to the party on addressing prescription drug abuse, and left to state Medical Boards, which have been accused of bailing on the party altogether, the definition of “inappropriate” could be bent, twisted, contorted, and most dangerously, broadened to encompass practices and procedures which a better informed or more detached observer would never contemplate. But when the warrant is signed or the cuffs slapped on, it’s too late for a healthcare provider to say, “Let’s slow down, back up, look at this from the beginning, and then discuss.”

That is why every healthcare provider, risk manager, medical group manager and professional needs to know the black-letter federal and state law of Schedule II-V prescriptions, and the nuances and subtleties of how the law is interpreted, what influences and impacts the agencies charged with “cracking down” on supposedly corrupt providers, and what you can do now, today, to ensure patient safety and the protection of your practice. This is why PAINKILLER LAW exists. Don’t let yourself fall victim to the subjective and loosey-goosey way law enforcement agencies and Medical Boards are defining “inappropriate,” “overprescribing,” “gross negligence,” or other concepts whose interpretation could be fraught with peril for even the most honest and ethical MD, osteopath, or physician’s assistant. Let us help you verify, achieve and maintain full compliance with the laws that well-intentioned but hopelessly biased drug agents are ever more aggressively attempting to enforce.

PAINKILLER LAW – It’s good preventative medicine.

info@painkillerlaw.com 213.293.3737 MEISTER LAW OFFICES

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PAINKILLER LAW: Fear and Self-Loathing in the Medical Academy

A recent article by Drs. Zachary Meisel and Jeanmarie Perrone, who teach at the University of Pennsylvania Medical School, asks whether “conscientious and well trained” doctors are to blame for prescription drug abuse. The authors say “yes.” That is, they say doctors are partially to blame, but the authors stay silent on why anyone else might be. That silence is damning, the good professors’ assessment is wrong, and their article is of great concern.

Not only is Rx abuse far too complex a problem to “blame” on any one constituency, but even more critically, it is always unsettling and even scary when one or two members of a profession presume to apologize on behalf of their colleagues nationwide for some perceived wrong. Today across the country we are seeing what the White House Drug Czar has called an “epidemic” of Rx abuse. We are also in response seeing a misplaced, hamfisted law enforcement approach to what is, in all but the most extreme cases, a public health problem. Federal and state law enforcement agencies will only be emboldened by an article whose glittering generalities
help legitimize the illegitimate and ill-advised belief that routinely going after doctors for alleged criminal conduct is the solution.

So are doctors to blame? In PAINKILLER LAW’s view, no, except in the most extreme cases. If a healthcare provider screens a patient carefully, does a thorough exam and makes an informed diagnosis, prescribes within the boundaries of established safety for an approved drug, counsels the patient on the possibility of addiction, monitors the patient conscientiously, verifies with any available prescription drug database, and uses his or her best judgment about how the patient is doing, what is the basis for a criminal charge against that doctor in the event of addiction or an overdose? Can the authors enlighten us, please, before asserting that good doctors are partly to blame?

Who else might be to “blame?” Patients themselves? That notion borders on blasphemy within the White House Drug Czar‘s Office; don’t be “blaming the victim,” the reasoning goes. What about Big Pharma? The drug companies marketed the pain-relieving powers of Oxy and its many opioid cousins back in the late 1980′s and early 1990′s. Were they wrong about the pain-relief qualities of the medications? Did they purposely understate the potentially addictive qualities of the drugs? What about medical schools and the philosophical and educational change that took place around the same time, so that med students would be trained to acknowledge and treat severe pain? Should we indict your school’s Academic Senate?

The point is, it’s too easy, suspiciously easy, to blame doctors, and that’s precisely what should make folks like Professors Meisel and Perrone think twice and choose their words carefully before they effectively if inadvertently bless today’s ill-conceived law enforcement priorities. Because if they’ve ever written a pain scrip themselves, they may have just made what an excitable cop or prosecutor might call a confession.

PAINKILLER LAW: CRIMINAL LAW COMPLIANCE FOR HEALTHCARE PROVIDERS. 213.293.3737 info@painkillerlaw.com

The Meister Law Offices

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PAINKILLER LAW: ONDCP TO OFFER ONLINE TRAINING IN GUIDELINES FOR WRITING PAIN Rx’S

The National Office of Drug Control Policy has announced that it will offer online training to healthcare providers, medical students and interns, and medical schools about the guidelines providers should follow in deciding whether to prescribe or refill Schedule II painkillers.  This is good news.

To be effective and useful for providers, the guidelines must have a real-world orientation, not some high-minded but utterly unrealistic set of goals providers should strive to achieve.  I strongly urge providers to incorporate study of these guidelines into their practices immediately, as a proactive means of complying with federal and state criminal laws governing the prescription of Schedule II painkillers.  This is because, as the Painkillerlaw Blog has talked about before, there are both written and unwritten guidelines and criteria that the federal and state government law enforcement agencies investigating overdoses and healthcare providers follow.  The more the government has put in writing about what you as a provider should do or pay attention to in this area of your practice, the better prepared you will be not only to care for your patients, but to defend against government scrutiny in the event you find yourself the subject of an official probe, say if a patient of yours overdoses on painkillers you prescribed.  The more you can show a government investigator you are aware of the guidelines, and you follow them every day, the better the chances that you will not be unfairly blamed for a tragedy which might befall a patient but for which you should not bear legal or professional responsibility.

PAINKILLER LAW: CRIMINAL LAW COMPLIANCE FOR HEALTHCARE PROVIDERS is a service of the Meister Law Offices, and can help you verify, achieve and maintain compliance with the written, unwritten, clear, unclear, mandatory and discretionary enforcement guidelines and criteria in place nationwide and governing prescription of Schedule II painkillers.  Call us today for a free consultation at 213.293.3737, or email us at info@painkillerlaw.com.

 

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PAINKILLER LAW: THE NEW “BLAME GAME” IN Rx ABUSE

Did you as a medical doctor, osteopath, physician’s assistant or pharmacist know that YOU are to blame for Rx abuse nationwide?  The White House Office of National Drug Control Policy is placing new emphasis on treatment and prevention of Rx abuse and urging a new, more “compassionate” model be adopted when it comes to how patients abusing prescription painkillers should be approached.  But blame for Rx abuse has to be placed somewhere.  And so it has been placed on healthcare providers who write painkiller prescriptions, and the pharmacists who fill them.

Look no further than an article in Wednesday’s Wall Street Journal for proof.  The article, “Making the Pharmacy Crawl,” explains that patients in many states have to travel to several pharmacies to fill legitimate prescriptions, as a result of new laws’ making “doctors criminally liable and revok[ing] their licenses for writing prescriptions for painkillers that lead to overdoses.”  This, in combination with pharmacies’ being subject to stricter limits on how many opioids they can dispense in a given period, has led, says the article, to a reduction in the number of doctors writing prescriptions, and in pharmacies’ not being able to fill what even a legitimate patient with a legitimate scrip might need. Is this really helping people? Or is it placing doctors’ judgment under a microscope, allowing if not requiring scrutiny of medical judgment, by government agents with no medical training or experience?  Is it substituting pharmacists’ judgment, discretion and ethics for hard and fast marching orders from the DEA?  Is it going to do anything to crack down on what the government calls the prescription painkiller epidemic, or will it just make people’s lives harder, subject them to more unwanted bureaucracy, and punish ethical practitioners and legitimate patients along with a few corrupt practitioners and drug addicts?

Ham-fisted governmental action that creates unintended consequences for good and law-abiding people abound, especially in an environment like this where the government is basically feeling its way as it goes.  When government treats a public health problem as a law enforcement problem, there is going to be a lot of collateral damage behind every press release or high profile arrest.  Don’t be the collateral damage.  Protect yourself and your practice from governmental heavyhanded behavior, by being in compliance now with all applicable criminal laws about prescribing painkillers.  Compliance goes a long way; it makes for ethical and sound patient care; it gives you peace of mind that if you’re ever investigated you will be ready; it helps persuade law enforcement that you are practicing appropriately and properly; and it acts as a foundation for a defense if you ever need.

Call Painkiller Law, a service of the Meister Law Offices, today for a free consultation on how to verify, achieve and maintain criminal law compliance in writing prescriptions for pain medication.  It’s good preventative medicine.  213.293.3737, or write us at info@painkillerlaw.com.

 

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PAINKILLER LAW: CRIMINAL LAW COMPLIANCE FOR HEALTHCARE PROVIDERS

From the Meister Law Offices:

Doubtless in the past several years the availability and prescription rates of pain medication such as Oxycontin and other opioid derivatives have increased dramatically. So-called “pill mills” do exist; there is likely diversion of Schedule II narcotics from manufacturers, and perhaps some pharmacies, to the black market and the street.
However, the link law enforcement is drawing between illegal activity, and the everyday legitimate professional activities of the nation’s healthcare providers, has not been established. Since the vast majority of our nation’s healthcare providers are legitimate, ethical, honest and upstanding, the link will not be established. But don’t expect that to stop the DEA or local multiagency task force from busting in on your waiting room and announcing a search warrant. There goes your practice, your reputation, and possibly your license and livelihood.

Don’t become the next sacrificial lamb in the government’s game of enforcement catch-up. Just because it’s trendy and easy to blame healthcare providers for the problem of prescription painkiller abuse, doesn’t mean you should let the government have its way in destroying everything you worked so hard to build.

The way to protect your patients, your employees, your practice and yourself is by finding out and knowing now, today, whether your practice is in compliance with applicable federal and state criminal laws governing prescription, dispensing, and distribution of Schedule II painkillers. If you are ever audited, or otherwise find yourself under investigative scrutiny, you’ll want to know that you’re ready, that your practice is in full compliance with the law, and that you’ve nothing to fear from governmental attention.

Contact the Meister Law Offices, 213.293.3737 for a free consultation, or email us at info@painkillerlaw.com.

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PAINKILLER LAW: CRIMINAL LAW COMPLIANCE FOR HEALTHCARE PROVIDERS

Preventive Medicine Every Healthcare Practice Needs

The Meister Law Offices provides criminal law compliance legal services for healthcare providers who write prescriptions for Schedule II painkillers and pain medication. No healthcare practice can afford to risk noncompliance at a time when healthcare practitioners and pharmacists are under unprecedented government suspicion and often incredibly reckless and injurious law enforcement activity. Our firm’s unique “CCC – Comprehensive Compliance Checkup” – is a pioneering approach to this issue, and offers MD’s, DO’s, PA’s and pharmacists the thorough and in-depth analysis their practices need to achieve and maintain compliance with all laws regulating prescription painkillers and pain medication.

If you are a medical doctor, doctor of osteopathy, physician’s assistant, or a pharmacist, your profession is under federal and state law enforcement scrutiny worse than at any time in decades. This is not because of anything you’ve individually done; it is because the government believes there is an epidemic of prescription painkiller abuse in the United States.

These days the DEA and state and local law enforcement around the nation are raiding doctor’s offices, medical clinics, pharmacies, distribution centers and other healthcare providers’ facilities in search of what is suddenly being called the latest trend in American drug abuse.  Do not let yourself be the next victim.  Call the Meister Law Offices today at 213.293.3737 for a free consultation, or email us at info@painkillerlaw.com

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