In response to the prevailing epidemic of
narcotics addiction and its staggering toll on
society, Congress passed the federal Compre-
hensive Drug Abuse Prevention and Control
Act of 1970. In Section 801, Congress clearly
acknowledged that “[m]any of the drugs included
within this subchapter have a useful and legit-
imate medical purpose and are necessary to
maintain the health and general welfare of the
American people,” but then declared that “[t]he
illegal importation, manufacture, distribution,
and possession and improper use of controlled
substances have a substantial and detrimental
effect on the health and general welfare of the
The stated purpose of the legislation was to
enhance government oversight of the manufac-
ture, importation, distribution, and dispensing
of specified controlled substances, which are
classified in five schedules, depending in part on
their respective degrees of medical efficacy and
Title II of the 1970 statute requires all participants in the supply chain to register with the
Drug Enforcement Administration (DEA). The
statute imposes extensive obligations on registrants—including physicians—and requires
individuals and entities to keep accurate records
of inventories and to maintain proper security. In
effect, Congress created a well-defined “closed”
system permitting all controlled substances to
be tracked at every stage of the supply chain,
including both wholesale and retail.
Additionally, DEA periodically issues policy
statements providing further guidance regarding
enforcement of the statute.
Where Are We Today?
Under existing federal and state laws, the unauthorized possession, distribution, or use of a
controlled substance constitutes a crime. A number of factors, including the nature and schedule
designation of the drug, the quantity involved in
the investigation, prior convictions, and the commercial nature of the transaction will determine
whether the violation will be charged as a felony
or a misdemeanor, the length of incarceration,
and potential monetary fines.
Unfortunately, criminal laws are often complex,
enforcement is not uniform, and the underlying
causes of the problem, although better understood, are not being dealt with systemically with
any degree of consistency.
To limit patient mortality and morbidity
related to opioid overdose, all states have now
created separate electronic databases known
as Prescription Drug Monitoring Programs
(PDMPs). 4 Each database details the process
for prescribing controlled substances within
the state and enables physicians to view a
patient’s prescribing history to evaluate whether
a controlled substance may be appropriate and
effective. Health and law enforcement personnel are also generally authorized to access the
system to obtain providers’ prescribing patterns
as well as important information regarding
patient behaviors. A principal goal is to safeguard patients who may be at risk for addiction
or overdose. The scope and requirements of
PDMPs vary by jurisdiction.
What can your medical practice do to deal with
this patchwork collection of federal and state
government responses to the opioid crisis and
alleviate fears of criminal and civil penalties and
medical malpractice lawsuits?
F Strongly encourage your physicians to follow
CDC guidelines on treating chronic pain
patients with opioids.
F Know your responsibilities under federal and
state law when considering a prescription for
a controlled substance.
F Check to confirm that your physicians are in
compliance with applicable state PDMP requirements in the states where they practice.
Rich Cahill, Esq., is vice president and associate
general counsel, The Doctors Company.
1. Associated Press. 2019. Kansas Doctor Sentenced
to Life in Prison for Patient Death. March 8, 2019.
Accessed April 17, 2019, at nbcnews.com/news/
2. Centers for Disease Control and Prevention.2017.
CDC Guideline for Prescribing Opioids for Chronic
Pain. August 29, 2017. Accessed April 17, 2019, at
3. D. Dowell, T.M. Haegerich, and R. Chou. 2016. CDC
Guideline for Prescribing Opioids for Chronic Pain–
United States, 2016. Morbidity and Mortality Weekly
Report 65( 1): 1–49. Accessed April 17, 2019, at cdc.
4. Federation of State Medical Boards. 2019.
Prescription Drug Monitoring Programs: State-by-State Overview. Accessed April 17, 2019, at fsmb.
Criminal laws are
not uniform, and
not being dealt
with any degree