Enough about barriers and fear already--the pain community needs to be proactive and take steps to stop the "roulette wheel".

I read Jung and Reidenberg’s article, Physicians Being Deceived , several times, and each time I had a different reaction to it. While I respect the authors and their efforts to tackle tough issues relating to the use of controlled substances to treat pain, Jung and Reidenberg’s article troubles me because it oversimplifies critical issues. As discussed below, I believe the authors’ oversimplification of critical issues may well contribute to the fear and prescribing barrier they reference. I suggest individual physicians and the pain community as a whole must say “enough already to barriers and fear” and take back their turf and medical decision making by focusing on proactive measures designed to improve the clinical process, integrate law and medicine in terms of balanced pain policy, and protect patient access to pain management. My commentary builds upon Jung and Reidenberg’s ultimate and valid suggestion that physicians must document carefully the legitimate medical reason for their decision to use opioids with any patient. Jung and Reidenberg do not give readers any supporting facts from Ziegler’s survey and oversimplify its results, even ignoring that overall most prosecutors would have referred the case involving the chronic, noncancer pain patient to the licensing board; they do not discuss the facts of the Drug Enforcement Administration undercover cases, and they rely on the not so reliable media when arguing about criminal intent issues, thereby making it seem as if the “should have known” arguments by prosecutors are good enough to throw doctors in jail. Jung and Reidenberg argue that while doctors “must make every reasonable effort to confirm the diagnosis and need for opioid therapy, allowance must be made for the fact that conscientious doctors can be deceived.”