Physicians being deceived.

OBJECTIVE: In several high profile prosecutions of physicians for prescribing opioids, prosecutors claimed that the doctors should have known the individuals were feigning pain solely to obtain the prescriptions. This study was to determine how readily physicians can tell that patients lie. METHODS: A literature search was done for studies of standardized patients used to evaluate physicians' practices. Standardized patients are actors taught to mimic a patient with a specific illness. The papers were then reviewed for the frequency with which the physician correctly identified which office visits were by the standardized (lying) patients. RESULTS: Six studies of practicing physicians using standardized patients reported the frequency with which these actors were identified as the standardized patients. This occurred around 10% of the time. Some real patients were erroneously identified as the actors. CONCLUSION: Deception is difficult to detect. In the current legal climate surrounding prescribing opioids, accepting patients' reports of pain at face value can have significant legal consequences for the doctor. While doctors must make every reasonable effort to confirm the diagnosis and need for opioid therapy, allowance must be made for the fact that conscientious doctors can be deceived.

The risk of action by the Drug Enforcement Administration against physicians prescribing opioids for pain.

OBJECTIVE: Fear of government actions against physicians for prescribing opioids for their chronic pain patients is a cause for undertreatment of pain. This study was conducted to assess the risk of action by the federal Drug Enforcement Administration (DEA). METHODS: The DEA responded to a written request with a list of all DEA arrests in fiscal 2003. The Federal Register was reviewed for all revocations of DEA registrations for 2003 and 2004. RESULTS: There were 47 arrests in 2003 from among 963,385 doctors registered with the DEA and 56 revocations of registration seen in the 2003 and 2004 period. The reasons for these actions included loss of medical license, fraud, substance abuse by prescriber, sex in exchange for prescriptions, and prescribing without seeing patient. For the majority of cases, there was information to believe that a documented doctor-patient relationship with a chronic pain patient did not exist. CONCLUSION: When adequate documentation exists in the medical record, the risk of civil, criminal, or administrative action being taken by the DEA against a physician for prescribing opioids for a chronic pain patient is small.