• Controlled Substances Act,  Drugs,  Trials, Judges and Jurors

    Risk, Reward and Pain: Doctor Lessons from An Opioid Trial

    Opioid medications continue to be in the news, as demonstrated by the recent nationwide state attorneys-general investigation.  This situation only demands more attention from physicians and other healthcare providers who may face significant criminal sanctions. My law partner Brandon Essig recently wrote in Medical Economics: Over the past three decades, opioids have become a standard and effective component of pain management for many practitioners. They are effectively and safely prescribed in every conceivable clinical environment—primary care facilities, hospitals, pain management clinics and even dentist offices. They are prescribed to treat chronic and intractable pain, such as advanced stage cancer pain or severe burns, but they are also prescribed to treat soft…

  • Controlled Substances Act,  Health Care

    Stethoscopes, Handcuffs and Pain

    When does managing pain become a crime? And, what can a healthcare provider do to stay out of trouble in these days of the “opioid epidemic”, new federal legislation and the criminal prosecution of doctors? I make a few suggestions here in Pain Management News: That’s the question many physicians, nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs) and physician assistants (PAs) are asking in the wake of a tidal wave of prosecutions related to pain medicine. This has been partly spurred on by the “opioid epidemic.” There has been a sharp spike in convictions—either by guilty plea or by conviction after a trial—of health care professionals involved in pain medicine.…

  • Controlled Substances Act,  Drugs,  Trials, Judges and Jurors

    Mute Oracle: The Controlled Substances Act and Physicians’ Criminal Conduct

    Criminal laws are supposed to give persons regulated by the law sufficient notice of what conduct, exactly, is prohibited.  Criminal laws, as interpreted by courts, are also supposed to provide clear standards for mens rea (that is, the level of intent the Government must prove at trial).  With regard to physicians and their prescribing practices, the federal Controlled Substances Act does neither. Or, as my Lightfoot colleagues Brandon Essig, Jeff Doss and I put it in a recent article for Law 360: With the Eleventh Circuit’s recent decision in United States v. Enmon, physicians continue to face two critical questions in the uncertain case law under the federal Controlled Substances Act. First, what conduct…

  • Controlled Substances Act,  Drugs,  Poetry,  Trials, Judges and Jurors

    Pill Mills, Poppy Flowers, Dead Poets and the Human Resources Department

    Having been through a seven-week federal criminal “pill mill” trial, I think a lot about enforcement of the Controlled Substances Act and its effect on physicians.  Aggressive enforcement effects others in healthcare as well, including management: “It’s very hard for medical professionals and those in upper management, such as hospital CFOs, CEOs, and CMOs, to see themselves as criminals,” says Jack Sharman, partner at Lightfoot, Franklin, and White, a law firm headquartered in Birmingham, AL. “This difficulty to perceive what someone else might think merits a criminal investigation impedes judgment and slows internal response.” While physicians might not see themselves as criminals for managing patients’ pain or making sure they…