Risk of the View Through the Keyhole: There Is Much More to Physician Reactions to the DEA Than the Number of Formal Actions

Abstract

“The Risk of Action by the Drug Enforcement Administration Against Physicians Prescribing Opioids for Pain,” by Jung and Reidenberg, highlights important issues relating to physician fear of regulatory and legal scrutiny. While they clarify that few cases are ultimately brought to final action by the U.S. Drug Enforcement Administration (DEA), these physician fears are not necessarily based on exact calculations of prosecutions or regulatory actions. It seems that all you may need to change physician behavior is to simply advance intimidating policy statements or even initiate a few physician investigations that begin with a visit from DEA field agents dressed in flak jackets who carry weapons. Physician fear of regulatory scrutiny may not always be based on real threats, but they lead to real changes in prescribing behaviors that can substantially impair the treatment of patients in pain. The authors' usage of the term “action” in regard to the formal and final regulatory process that leads to revocation or arrest represents a semantic problem. The term may be technically correct when it comes to DEA protocol, but it is certainly not limited to this when you consider the experiences of many physicians who have directly or indirectly felt the actions of the DEA. These actions must be factored into any assessment of DEA impact, irrespective of whether or not they went on to revocation or arrest. The authors state that during just the first three quarters of 2003, 557 investigations were begun, but there is no mention of the impact of these investigations on the targeted physicians and the greater community during this relatively short period of time. These data suggest that it is possible that there may be significant risk of DEA intervention of some kind for a physician who prescribes sufficient opioids for many patients in chronic pain. …