In the midst of the opioid epidemic, the Supreme Court is set to rule on pivotal questions regarding physician liability for opioid prescription practices. Opioid regulation and prosecution have long attempted to balance the need to combat the opioid epidemic with the need to allow physicians to adequately treat patients suffering from chronic pain. In two separate criminal cases consolidated by the Supreme Court, the Court will finally address physician criminal liability under the Controlled Substances Act based on the over-prescription of opioids to patients. The outcome of the case will not only affect the two individual doctors involved – one is serving a 21-year sentence and the other a 25-year sentence – but will raise important considerations for the pain management field as a whole.
The central issue concerns the level of criminal intent required under the Controlled Substances Act to convict physicians accused of prescribing opioids outside the “usual course of professional practice.” Prosecutors advocate for an objective understanding of a physician’s “good faith” belief in prescribing the controlled substances, which both appellate courts upheld. The defendant-physicians, on the other hand, argue for a subjective interpretation allowing for a physician’s honest belief in prescribing.
This ruling will influence the delicate balance of legal intrusion into the medical industry. Proponents of employing an objective intent theory of liability highlight the need to combat the growing opioid epidemic and hold individuals responsible for their roles in the crisis. Supporters of a subjective reading fear that an objective requirement will lead physicians to base medical decisions, not on their own medical training and patient need, but on a fear of prosecution. This may lead to physicians becoming reticent to properly treat patients suffering from debilitating pain.
Whatever the outcome, pain management clinics and other practices that dispense opioids must continue to monitor, not only the medical, but the legal obligations when prescribing controlled substances.
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