Model Resolutions

Note: this resolution was defeated by one vote in the Arizona Medical Association House of Delegates. A substitute, weaker resolution was passed by ArMA and also by the AMA

RESOLUTION CONCERNING PAIN MANAGEMENT WHEREAS: Arizona physicians are facing intensified investigations and prosecutions for prescribing controlled substances for the management of chronic, nonmalignant pain, despite official reassurances that such prescriptions are lawful, that the evaluation of pain is subjective, and that the dosage prescribed must be a matter of professional judgment; and

WHEREAS: the process of a criminal investigation and indictment is itself destructive of a physician's practice, financial stability, and personal life; even if the physician is ultimately vindicated; and

WHEREAS: fear of such investigation or indictment deters physicians from prescribing appropriately and thus jeopardizes patients' access to treatments that could restore them to productive life, without which they are condemned to intense, needless suffering; and

WHEREAS: the perception that such investigations may be arbitrary and abusive undermines respect for the law; and

WHEREAS: drugs that may be substituted for opioids, such as nonsteroidal anti-inflammatories, have a much higher incidence of mortality and serious morbidity than opioids used as directed; and

WHEREAS: physicians have neither the authority nor the training to serve as law-enforcement agents; and

WHEREAS: the expectation that a physician treat every pain patient as a potential criminal suspect destroys the trust required for a patient-physician relationship; and

WHEREAS: appropriate dosage depends on the patient's metabolism and pathology, and the proportion of a physician's prescriptions that are for controlled substances depends on the nature of the physician's practice, so that there are no valid statistical tests to show that a physician is prescribing "too much,"

THEREFORE BE IT RESOLVED THAT: The Arizona Medical Association declare that:

1. Prescriptions for opioids are a matter of professional judgment. It is therefore inappropriate for licensing agencies or law enforcement agencies to set statistical criteria for "usual" prescription practices.
2. Errors in professional judgment are inevitable, as are differences of opinion regarding optimal patient management. Errors or disagreements are never to be construed as or treated as crimes. There is no crime in the absence of a mens rea.
3. Diagnosis and evaluation of patients is also a matter of professional discretion. There are no scientifically validated nor legally promulgated standards for making a determination that a prescription for a scheduled substance is or is not indicated. Thus, failure to follow a specified procedure is not a crime.
4. Physicians accused of illegally prescribing controlled substances are entitled to a presumption of innocence.

AND BE IT FURTHER RESOLVED THAT: The Arizona Medical Association work for the urgent enactment of legislation that would:

1. Create criminal penalties for an officer of any court within the State of Arizona who knowingly makes use of or suborns false testimony;
2. Prosecute any law enforcement officer who intimidates pain patients in an effort to induce testimony against a physician. In particular, prohibit depriving any detainee who is a potential witness against a physician of drugs prescribed for the relief of pain;
3. Require a determination by practicing physicians with expertise in pain management that a physician has a pattern of prescribing opioids in significant amounts to a significant proportion of patients without reasonable medical rationale before embarking on a criminal investigation;
4. Require that undercover agents imitate the behavior of addicts trading money for prescriptions rather than that of genuine pain patients and that all testimony by such agents be accompanied by a complete tape recording of the entire first encounter.
5. Require that juries in cases involving pain management be made aware of any incentives offered to witnesses in exchange for their testimony.

AND BE IT FURTHER RESOLVED THAT: the Arizona Medical Association urge the American Medical Association to work for similar reforms on the federal level to curb prosecutorial abuse.