Thorough documentation, Supreme Court ruling may reassure providers considering opioids
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SAN DIEGO — Thoroughly documenting all patient interactions may help address physicians’ trepidation regarding opioid prescriptions, according to a speaker at the Congress of Clinical Rheumatology West.
According to Stephen J. Ziegler, PhD, JD, professor emeritus at Purdue University, differing guidelines imposed by various governmental bodies can make the process difficult for physicians who are considering opioids for their patients. For example, fear of legal repercussions can deter some providers from prescribing opioids altogether, he said.
“I can recognize that prescribers are afraid, and they are opting out,” Ziegler told attendees.
However, a recent U.S. Supreme Court ruling may alleviate such fears.
In 2022, the court ruled unanimously that it must be proven beyond a reasonable doubt that a defendant charged with writing an unauthorized prescription knew, at the time of writing, that the prescription would be classified as unauthorized according to federal guidelines. The decision, Ruan v. United States, overturned and vacated the convictions of three physicians who had previously been found guilty of overprescribing opioids in violation of the Controlled Substances Act.
“This is a start,” said Ziegler, who reported filing an amicus brief to the Supreme Court in the case. “At least it is a positive start in a positive direction.”
To protect themselves, Ziegler recommended that physicians make a habit of meticulously documenting interactions they have with patients and adhere to the prescribing guidelines of the state where they practice.
“There are certain expectations that your state regulators will provide,” he said. “And if you deviate from that, there may be some good reasons to do that.”
Any deviation from standard guidelines should be documented with notes detailing the reasons for the change, Ziegler said.
“Your own state guidelines would be instructive,” he said. “I would also encourage you to consult your state medical associations, because they would be a great resource as well.”
During a question-and-answer session following the lecture, attendees reflected on the hesitation they have in prescribing opioids due to the legal tensions. Ziegler encouraged the attendees to advocate for patients who they feel may benefit from opioid treatment.
“Speak out as a health care provider,” he said. “Make it known why this is wrong — you need to start somewhere.”
Meanwhile, although some clinics and physicians have instituted opioid agreements, Ziegler recommended caution.
“Sometimes these opioids agreements are not fair and balanced,” he said. “Sometimes they are not accurate, and sometimes they place the prescriber in the role of a policeman instead of a health care provider.”
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Ziegler SJ. Presented at The Congress of Clinical Rheumatology West; Sept. 7-10, 2023 (hybrid meeting).
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