National Association of Attorneys General

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Balancing Law Enforcement and Pain Management: NAAG Holds Roundtable

On September 22, 2008, NAAG hosted the Balanced Pain Policy Initiative’s second legal roundtable with the goal of establishing a set of suggested guidelines to assist law enforcement personnel in the investigation of physicians alleged to have mishandled or diverted controlled substances. Vermont Attorney General Bill Sorrell convened the meeting, attended by twenty-seven individuals representing prosecutors, investigators, medical boards, physicians, health insurers, ethicists, and others interested in health policy as it involves the undertreatment of chronic pain and the diversion of opioids and other controlled substances.

Discussion during the morning session centered around several case scenarios. The exchange of viewpoints from the varying professions represented was lively and educational. Former Nevada Attorney General Frankie Sue del Papa lent her considerable experience to the deliberation. While physicians informed the law enforcement community concerning standard treatment for various painful ailments, the prosecutors spoke about the ethical obligations prosecutors face, including the restrictions on commenting on cases and the concerns about parallel proceedings.

Oklahoma Attorney General Drew Edmondson presented a procedural template that his office has been following regarding investigations of physicians for controlled substance violations in their prescribing practices. Attendees then considered the various aspects of what General Edmondson calls a “righteous prosecution” against prescribers. Numerous ideas were suggested as to how law enforcement can fulfill its obligation to enforce the various controlled substances laws while remaining cognizant of the effect the enforcement might have on the prescribing community. Bill Colby from the Center for Practical Bioethics, acting as convener, was kept busy recording the various perspectives offered by those gathered around the table. Consensus was reached on many of the practices suggested. These ideas will be memorialized in a written document that will be circulated among the BPPI partners and those who met in D.C. with the goal of publishing these ideas as suggested guidelines that prosecutors might wish to adopt in analyzing fact scenarios involving physicians with questionable prescribing habits.

The Attorneys General are committed to finding methods by which to achieve a balanced pain policy. It is hoped that the document that will evolve from the discussions held at NAAG in September will assist prosecutors at the local, state, and federal level to achieve this goal.

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Tim Fox, Montana Attorney General

Tim Fox, the Montana attorney general, has worked in public service since 1990.