PUBLIC POLICY & REGULATION
e e
STEPHEN J. Zi GL R PHD, JD
by
abstract: Federal
and state governments have intervened in prescribing for well
over a century. The following article profiles 5 interventions designed to reduce the
harms associated with prescription drug abuse. However, the potential for “medicolegal iatrogenesis” (patient harm stemming from governmental intervention) is
raised, as well as the need to maintain the delicate balance between ensuring access to opioids while preventing their abuse and harm.
One of the primary purposes of government is to protect the health, safety,
and welfare of its citizens. Pursuant to this laudable goal, governments at all levels
in the United States have created laws and regulations in an effort to protect people
from a wide range of potentially harmful products and services. This certainly was
the case in the late 1800s when opioids were essentially unregulated and virtually
anyone could hold themselves out as a healthcare provider.1
Today, although many things have changed, the challenges associated with
ensuring access to opioids while simultaneously preventing their abuse remain the
same. Recent data indicate an alarming increase in opioid-related deaths2 while at
the very same time an estimated 100 million people in the United States suffer from
chronic pain.3 Although recent government interventions to address the harms associated with opioid abuse have expanded, efforts to simultaneously ensure access
have not. In an effort to advance balanced policy,4 the following article explores
5 governmental interventions in prescribing and discusses their potential for what
I term medicolegal iatrogenesis (patient harm stemming from governmental
intervention). The article concludes by recommending greater involvement by prescribers in the regulatory process.
“Intervention must be influenced by the active participation of all stakeholders, including prescribers.”
40 | PWJ | www.painweek.org
Q3 | 2013