As the nation attempts to combat the opioid crisis, some industry observers believe certain federal actions taken in the past few months have simply gone too far. In recent cases, agents executed search warrants on medication assisted treatment (MAT) providers with no obvious rationale.
The raids were unwarranted, according to Michael Barnes, managing partner at DCBA Law & Policy, who represents providers. He tells Behavioral Healthcare Executive he’s concerned that Attorney General Jeff Sessions and the Department of Justice (DOJ), under his direction, are out of alignment with the Trump administration’s current position on the opioid crisis.
“Health and Human Services Secretary Alex Azar is onboard, and [the president’s counselor] Kellyanne Conway is doing a great job at supporting this—so is the Food and Drug Administration and the National Institutes of Health,” Barnes says. “Everyone except DOJ.”
In a letter to the president, DCBA Law & Policy calls for the dismissal of Sessions, the suspension of DOJ criminal investigations against physicians prescribing MAT, and the development of a process to ensure criminal investigations are conducted only with referrals from state licensing boards.
What’s especially concerning to Barnes is the fact that two of the physicians targeted are, in his assessment, clearly reputable providers. Stuart Gitlow, MD, MPH, MBA, DFAPA, the past president of the board of the American Society of Addiction Medicine (ASAM) was the subject of one of the raids in March.
Gitlow, who is a general, forensic and addiction psychiatrist and prescribes MAT drugs, confirms to BHE that his home and his private practice were raided by FBI agents with search and seizure warrants.
Earlier this month, federal agents also searched Watauga Recovery Centers in Virginia and Tennessee and seized patient records. Ralph Thomas Reach, MD, president and founder of the organization, is also the past president of the Tennessee Society of Addiction Medicine. He helped craft the state law for MAT, and is on the ASAM legislative committee.
He told the Johnson City Press that there are no medications kept at the treatment centers, and the organization doesn’t work with any federal or state health insurance programs that might be under the purview of special fraud investigation teams.
“These are not criminal cases,” Barnes says. “These are cases where the Department of Justice is going after some of America’s best addiction physicians for questionable medical conduct at best.”
He believes the intent is to create a chilling effect on the use of MAT drugs, even though the Trump administration has overtly favored access to MAT as a policy to address the opioid crisis.
“There is excessive enthusiasm on the part of Jeff Sessions to raid doctors,” Barnes says.
State board oversight
Ordinarily, questionable medical conduct, such as suspected diversion or overprescribing, might be a case for state medical boards to examine. Physicians violating accepted standards would be investigated by a board of professionals to distinguish whether the offense warrants suspension of the license to practice or action from law enforcement.
“When there is any medical question about a prescriber’s conduct, that question should be referred to the state professional licensing board, which can then conduct an investigation and refer criminal conduct to law enforcement,” Barnes says. “That’s what should be happening. Period.”
But not all boards have the resources to follow up on every situation. That’s why Barnes believes some of the federal opioid-related funds should be funneled to medical boards for that purpose. He says his firm is working pro-bono to advance a policy for a medical-board-referral requirement before federal investigation or prosecution of physicians.
The Federation of State Medical Boards prepared a brief in 2009 that had the support of attorneys general, the Drug Enforcement Agency (DEA) and others in law enforcement. While it was framed specifically to position best practices in investigating potential diversion of pain medications, Lisa Robin, chief advocacy officer of the federation, tells BHE the approach certainly applies to the medications used to treat addiction disorders.
“The principles of cooperation between regulatory bodies that oversee professionals and law enforcement are critical regardless of what the issue is,” Robin says. “It doesn’t matter if it’s opioids or Suboxone or anything else. The principles are still solid.”
She emphasizes the fact that the federation’s template calls for medical expertise to evaluate a physician’s conduct.
“We worked for years with DEA and state medical boards and law enforcement, urging that there be cooperation in the investigations, that you look at the practice, and that there be expertise in the medical field to gauge if the provider was negligent or strayed away from standard of care,” she says.
The bottom line for treatment providers is that at the very least they must reduce their risk by keeping excellent documentation when prescribing MAT drugs. There’s also an opportunity to advocate for policies that balance the significant need for access to addiction treatment with the need to ambush those engaging in diversion.