Investigating Opioid Misuse

Lynn R. Webster, MD

Disclosures

March 24, 2010

Question

Shouldn't there be a law that all investigations of opioid prescribing be overseen by a physician, preferably one who is certified in the field of pain management?

Response from Lynn R. Webster, MD
Medical Director, Lifetree Clinical Research and Pain Clinic, Salt Lake City, Utah

Treating pain is complicated, and law enforcement authorities have expressed the need for help in evaluating cases, suggesting that access to a pool of national experts for consultation could be useful.[1] As a result, leaders of pain organizations such as the American Academy of Pain Medicine, the American Pain Society, and the American Pain Foundation, have agreed to help establish a registry of knowledgeable board-certified physicians for this purpose.[1] State medical boards that have not already done so are advised to study and adopt the "Model Policy for the Use of Controlled Substances for the Treatment of Pain"developed by the Federation of State Medical Boards,[1] which contains the basics of good pain management and is available as an education tool for law-enforcement authorities as well.

Expert witnesses called to testify often offer conflicting opinions and interpretations of medical literature related to opioid prescribing. Many states have regulations aimed at maintaining the quality and integrity of expert testimony in pain-related fields such as neurology and neurosurgery; however, no guidelines for pain medicine expert testimony currently exist.

To lessen the potential for sub-par testimony, pain-related expert witnesses should [2]:

  • Be full-time physicians;

  • Be active in practice caring for the type of patient involved in the legal action;

  • Alternatively, be able to demonstrate competence in the medical area of interest; and

  • Provide honest, evidence-based testimony that is current with scientific evidence and free of bias.

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