Health Care Law Blog

Precautions of Prescribing Controlled Substances for Pain

In response to growing concerns about prescription drug abuse, there has been a significant increase in investigative and enforcement activities by state licensing authorities as well as local, state and federal law enforcement. We have been contacted by physicians who want to care for patients with chronic or intractable pain but are concerned about the consequences to their licenses and practices that might result if investigators question their decision to prescribe controlled substances.  Given the current environment, it is a good idea for physicians to refresh themselves on the legal requirements for effective pain management.

Michigan’s Public Health Code provides a “safe harbor” for physicians who prescribe pain medication as part of legitimate medical practice.  A physician who prescribes narcotic controlled substances as part of a medical treatment plan for a patient with reduced life expectancy due to advanced illness is immune from administrative and civil liability if certain requirements are met.  The prescription must be issued in good faith with the intention to: (1) treat a patient with reduced life expectancy due to advanced illness or (2) alleviate the patient's pain.  In addition, the prescription must be for a legitimate legal and professionally recognized therapeutic purpose.

Physicians should review the Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain, which summarize the standard of care for managing pain patients. The relevant licensing boards – the Board of Medicine, Board of Osteopathic Medicine and Surgery and the Board of Pharmacy- expect physicians to be familiar with these standards and comply with the requirements before prescribing narcotics for pain management.  In general, a physician who follows the guidelines will be viewed as acting in good faith and issuing prescriptions for legitimate therapeutic reasons.

It is also helpful to review the DEA's Practitioner Manual to ensure compliance with federal rules and regulations.  Beyond meeting the baseline standard of legitimate therapeutic purpose, physicians must comply with many technical requirements when prescribing or dispensing controlled substances.

Finally, it may be prudent to seek legal and expert advice to make sure that your practice complies with existing laws, regulations and the applicable standards of care.  There have been recent changes in the requirements for delegating prescribing authority to mid-level practitioners, record-keeping for controlled substance prescriptions, and transmitting controlled substance prescriptions to pharmacies.  A practice audit can help avoid unwanted problems.  For help with controlled substance issues please contact Richard Kraus at (517) 371-8104 or by using the form below.

Categories: Hospitals, Physicians, Regulatory