Despite widespread efforts to reduce illegal or "non-therapeutic" prescribing, physicians rarely face criminal penalties, according to an investigation by the Austin American-Statesman published in the Miami Herald.
In Texas, one of the original hot spots for pill mills and doctor shopping, criminal charges were filed against fewer than one-third of the 83 doctors punished by the Texas Medical Board in the past three years for drug law violations involving two or more patients, the investigation found.
But Texas is hardly the only state where physician prosecutions are unusual, experts told the newspaper, adding that proving a doctor's medical misjudgment rises to the level of criminal behavior can be difficult. What's more, physicians have become more aggressive in fighting accusations from the medical board, said Michael Arambula, M.D., the Texas board's president. "Physicians fight these cases like they're in court," he said. "I wish we could do things quicker."
Another missed opportunity to address the opioid crisis is physicians' reluctance to check patients' prescribing history via online prescription monitoring programs, noted the newspaper.
The problem isn't so much that physicians don't believe in the usefulness of the database, according to Arambula, but that they're already overburdened with other administrative tasks.
Nonetheless, three states now require providers to check the database before writing prescriptions for controlled substances. Massachusetts, the most recent state to add the mandate, promulgated final regulations in December that require physicians to access the database and research a patient's history before they prescribe a Schedule II or III medication or a benzodiazepine to a patient for the first time, according to an announcement. The rules do, however, allow prescribers to appoint delegates to check the database on their behalf to more readily fit into practice workflow.