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Physician Autonomy and the Opioid Crisis

Published online by Cambridge University Press:  01 January 2021

Nathan Guevremont ,
Mark Barnes  and
Claudia E. Haupt
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Extract

The scope and severity of the opioid epidemic in the United States has prompted significant legislative intrusion into the patient-physician relationship. These proscriptive regulatory regimes mirror earlier legislation in other politically-charged domains like abortion and gun regulation. We draw on lessons from those contexts to argue that states should consider integrating their responses to the epidemic with existing medical regulatory structures, making physicians partners rather than adversaries in addressing this public health crisis.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 46 , Issue 2: Law and the Opioid Crisis: An Inter-Disciplinary Examination , Summer 2018 , pp. 203 - 219
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

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References

“Prescription Opioid Overdose Data,” August 2017, accessed January 23, 2018, available at <https://www.cdc.gov/drugoverdose/data/overdose.html> (last visited March 30, 2018).+(last+visited+March+30,+2018).>Google Scholar
Connery, H.S., “Medication-Assisted Treatment of Opioid Use Disorder: Review of the Evidence and Future Directions,” Harvard Review of Psychiatry 23, no. 2 (2015): 63-75.Google Scholar
21 U.S.C. 823(g) (2012).Google Scholar
21 C.F.R. § 1306.04 (2017); see also Rastogi, R. and Meek, B.D., “Management of Chronic Pain in Elderly, Frail Patients: Finding a Suitable, Personalized Method of Control,” Clinical Interventions in Aging 8 (2013): at 37 (discussing the use of methadone in elderly populations with chronic pain).CrossRefGoogle Scholar
105 Mass. Code Regs. 700.012(G) (2017).CrossRefGoogle Scholar
See Carlson, D. and Thompson, J.N., “The Role of State Medical Boards,” Virtual Mentor 7, no. 4 (2005), available at <http://virtualmentor.ama-assn.org/2005/04/pdf/pfor1-0504.pdf> (last visited March 30, 2018).Google Scholar
See, e.g., Demint v. State Med. Bd. of Ohio, 70 N.E.3d 21, 29–30 (2016) (reviewing a physician’s treatment of a patient with fibromyalgia, and concluding that a narcotic prescription was inappropriate under the circumstances); Ruger, T.W., “Plural Constitutionalism and the Pathologies of American Health Care,” Yale Law Journal Online 347, no. 120 (2011), available at <http://yalelawjournal.org/forum/plural-constitutionalism-and-the-pathologies-of-american-health-care> (last visited March 30, 2018) (noting that medical decision making is legally “devolved to the most particularized level of the delivery system”).Google Scholar
See 21 C.F.R. § 1306.04 (2017) (prohibiting physicians from prescribing methadone for addiction treatment, but allowing prescriptions for pain); 21 U.S.C. 823(g) (2012) (limiting the number of patients to whom physicians may prescribe buprenorphine for addiction treatment).Google Scholar
See Ruger, supra note 7.Google Scholar
Massachusetts Board of Registration in Medicine, Prescribing Practices: Policy and Guidelines, 2015, at 8, 12, available at <http://www.mass.gov/eohhs/docs/borim/policies-guidelines/policy-15-05.pdf> (last visited March 30, 2018).+(last+visited+March+30,+2018).>Google Scholar
Vulliamy, A.P. and Sullivan, R., “Reporting Child Abuse: Pediatricians’ Experiences with the Child Protection System,” Child Abuse and Neglect 24, no. 11 (2000): 1461-1470.CrossRefGoogle Scholar
Daniels, R.S, Baumhover, L.A., and Clark-Daniels, C.L., “Physicians’ Mandatory Reporting of Elder Abuse,” The Gerontologist 29, no. 3 (1989): 321-327.CrossRefGoogle Scholar
Chorba, T.L., Berkelman, R.L., Safford, S.K., Gibbs, N.P., and Hull, H.F., “Mandatory Reporting of Infectious Disease by Clinicians,” Morbidity and Mortality Weekly Report: Recommendations and Reports 39, no. RR-9 (June 22, 1990): 1-17.Google Scholar
Weinbertg, S.E. et al., “Legislative Interference with the Patient-Physician Relationship,” New England Journal of Medicine 367, no. 16 (2012): 1157-1559, at 1557.Google Scholar
Ruger, T.W., “Of Icebergs and Glaciers: The Submerged Constitution of American Healthcare,” Journal of Law and Contemporary Problems 75, no. 3 (2012): 215-235, at 217-220.Google Scholar
See “U.S. Medical Regulatory Trends and Actions,” Federation of State Medical Boards of the United States 6 (2016), available at <https://www.fsmb.org/globalassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf> (last visited May 29, 2018).+(last+visited+May+29,+2018).>Google Scholar
See Curess, S.R. and Cruess, R.M., “The Medical Profession and Self-Regulation: A Current Challenge,” Virtual Mentor 7, no. 4 (2005), available at <http://journalofethics.ama-assn.org/2005/04/pdf/oped1-0504.pdf> (last visited March 30, 2018).Google Scholar
See “State-Specific Requirements for Medical Licensure,” Federation of State Medical Boards of the United States, available at <https://www.fsmb.org/licensure/usmle-step-3/state_specific> (last visited March 30, 2018).+(last+visited+March+30,+2018).>Google Scholar
“Position Paper: Non-Invasive Vascular Testing,” State Medical Board of Ohio (May 10, 1995), available at <http://www.med.ohio.gov/Portals/0/DNN/PDF-FOLDERS/Laws-Rules/Position-Statements/Non-Invasive-Vascular-Testing.pdf> (last visited March 30, 2018).+(last+visited+March+30,+2018).>Google Scholar
See Federation of State Medical Boards of the United States, supra note 16, at 10.Google Scholar
Radley, D.C., Finkelstein, S.N., and Stafford, R.S., “Off-Label Prescribing Among Office-Based Physicians,” Archives of Internal Medicine 166, no. 9 (2006): 1021-1026.CrossRefGoogle Scholar
Hamel, S., McNair, D.S., Birkett, N.J., Mattison, D.R., Krantis, A., and Krewski, D., “Off-Label Use of Cancer Therapies in Women Diagnosed with Breast Cancer in the United States,” SpringerPlus 4, no. 209 (2015).Google Scholar
Neville, K.A., Frattarelli, D.A.C., Galinkin, J.L., Green, T.P., Johnson, T. D., Paul, I.M., and Van Den Anker, J.N., “Off-Label Use of Drugs in Children,” Pediatrics 133, no. 3 (2014): 563-567.Google Scholar
Weber, E.M., “Failure of Physicians to Prescribe Pharmaco-therapies for Addiction: Regulatory Restrictions and Physician Resistance,” Journal of Health Care Law and Policy 13, no. 1 (2010): 49-76, at 58.Google Scholar
Marshall, E., “Uncle Sam is the Worst Drug Fiend in the World,” New York Times, March 12, 1911, at SM12.Google Scholar
Id.Google Scholar
Harrison Narcotics Act of 1914, Pub. L. No. 63-223, 38 Stat. 785, repealed by Comprehensive Drug Abuse Prevention and Control Act of 1970, Pub. L. No. 91-513, 84 Stat. 1236 (codified as amended at 21 U.S.C. §§ 801–971 (2012)).Google Scholar
See Webb v. United States, 249 U.S. 96 (1919) (finding that a physician could not prescribe morphine to an individual with addiction because it would not “cure” his addiction but maintain his use); United States v. Doremus, 249 U.S. 86 (1919); United States v. Behrman, 258 U.S. 280 (1922).Google Scholar
Weber, supra note 24, at 60.Google Scholar
21 C.F.R. § 1301.1.1 (2017).Google Scholar
21 C.F.R. § 1306.04 (2017); 21 C.F.R. § 1306.07 (2017).Google Scholar
21 C.F.R. § 1306.04 (2017); 21 C.F.R. § 1306.07 (2017).Google Scholar
Narcotic Addict Treatment Act (NATA) of 1974, Public L. No. 93-281.Google Scholar
146 Cong. Rec. S11892-03 (2000) (statement of Sen. Carl Levin).Google Scholar
21 U.S.C. § 823(g) (2012).Google Scholar
See Gonzalez v. Oregon, 546 U.S. 243, 270 (2006).Google Scholar
“Opioid Overdose Death Rates and All Drug Overdose Death Rates per 100,000 Population (Age-Adjusted),” Henry J. Kaiser Family Foundation (2016), available at <https://www.kff.org/other/state-indicator/opioid-overdose-death-rates/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D> (last visited March 30, 2018).+(last+visited+March+30,+2018).>Google Scholar
See, e.g., Mass. Gen. Laws ch. 94C, § 34A.Google Scholar
“2017 State & Legislative Partisan Composition,” National Conference State Legislatures (2017), available at <http://www.ncsl.org/Portals/1/Documents/Elections/Legis_Control_2017_111017_1pm.pdf> (last visited March 30, 2018).+(last+visited+March+30,+2018).>Google Scholar
Id.Google Scholar
Id.Google Scholar
Mass. Gen. Laws ch. 94C, § 19D (2018).Google Scholar
Id.Google Scholar
243 Mass. Code Regs. 2.07(25) (2018).Google Scholar
Mass. Gen. Laws ch. 94C, § 24A (2018); 105 Mass Code Regs. § 700.012(G) (2018).Google Scholar
Mass Gen. Laws ch. 94C, § 18 (2018).Google Scholar
Board of Registration in Medicine, supra note 10, at 8–10.Google Scholar
N.H. Code Admin. R. Ann. Med 502.04 (2018).Google Scholar
N.H. Code Admin. R. Ann. Med. 502.04 to .05.Google Scholar
N.H. Rev. Stat. Ann. § 318-B:41; N.H. Code Admin. R. Med. 502.06 (2018).Google Scholar
NH Rev. Stat. Ann. § 318-B:40 (2018).Google Scholar
N.H. Code Admin. R. Ann. Med. 502; N.H. Rev. Stat. Ann. § 332-B:7- a (granting rulemaking authority to the Medical Board for rules on opioid use and prescribing).Google Scholar
N.H. Rev. Stat. Ann. § 318-B:2 (2018).Google Scholar
Ohio Admin. Code 4731-11-13 (2018).Google Scholar
Ohio Rev. Code Ann. § 3719.061 (West 2018).Google Scholar
Ohio Rev. Code Ann. § 4731.055 (West 2018).Google Scholar
Ohio Admin. Code 4731-21-03 (2018).Google Scholar
Ohio Admin. Code 4731-21-02 (2018).Google Scholar
Ohio Rev. Code Ann. § 4731.052 (West 2018).Google Scholar
R.I. Code R. 31-2-6:4.4 (2018).Google Scholar
21 R.I. Gen. Laws § 21-28-3.18 (2018).Google Scholar
21 R.I. Gen. Laws § 21-28-3.32 (2018).CrossRefGoogle Scholar
R.I. Code R. 31-2-6:4.4 (2018).Google Scholar
R.I. Code R. 31-2-6:4.4 (2018).Google Scholar
23 R.I. Gen. Laws § 23-17-26.3 (2018).Google Scholar
W. Va. Code § 60A-9-5a (2018).Google Scholar
W. Va. Code § 30-1-7a (2018).Google Scholar
“Policy on the Chronic Use of Opioid Analgesics,” West Virginia Board of Medicine (Sep. 11, 2017), available at <https://wvbom.wv.gov/download_resource.asp?id=408> (adopting the Federation’s Model Policy) (last visited March 30, 2018).+(adopting+the+Federation’s+Model+Policy)+(last+visited+March+30,+2018).>Google Scholar
“Best Practices for Prescribing Opioids in West Virginia,” Office of the Attorney General of West Virginia (2016), available at <http://ago.wv.gov/Documents/2016.08.19%20BP%20Prescribing.PDF> (last visited March 30, 2018).+(last+visited+March+30,+2018).>Google Scholar
W. Va. Code Ann. § 30-3A-1 (2018).Google Scholar
Townley, C., “Massachusetts Becomes First State to Pass State-wide Cap on First Time Opioid Prescriptions,” National Academy of State Health Policy (March 15, 2016), available at <http://www.nashp.org/massachusetts-becomes-first-state-to-pass-statewide-cap-on-first-time-opioid-prescriptions> (last visited March 30, 2018).+(last+visited+March+30,+2018).>Google Scholar
“Prescribing Policies: States Confront the Opioid Overdose Epidemic,” National Conference State Legislatures (Sept. 2017), available at <http://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx> (last visited March 30, 2018).+(last+visited+March+30,+2018).>Google Scholar
Zezima, K., “With Drug Overdoses Soaring, States Limit the Length of Painkiller Prescriptions,’ Washington Post, August 9, 2017, available at <https://www.washingtonpost.com/politics/with-drug-overdoses-soaring-states-limit-the-length-of-painkiller-prescriptions/2017/08/09/4d5d7e0c-7d0f-11e7-83c7-5bd5460f0d7e_story.html> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
Id.Google Scholar
Id.Google Scholar
Dowell, D., Haegerich, T.M., and Chou, R., “CDC Guidelines for Prescribing Opioids for Chronic Pain — United States, 2016,” JAMA 315, no. 15 (2016): 1624-1645.Google Scholar
Board of Registration in Medicine, supra note 10.Google Scholar
Finklea, K., Sacco, L.N., and Bagalman, E., “Prescription Drug Monitoring Programs,” Congressional Research Service (2014), at 3, available at <https://fas.org/sgp/crs/misc/R42593.pdf> (last visited April 2, 2018); Prescription Monitoring Program Annual Report, Massachusetts Department of Public Health (April 2016): at 2 (noting that the Massachusetts database was established by regulation in 1992).+(last+visited+April+2,+2018);+Prescription+Monitoring+Program+Annual+Report,+Massachusetts+Department+of+Public+Health+(April+2016):+at+2+(noting+that+the+Massachusetts+database+was+established+by+regulation+in+1992).>Google Scholar
Id. (noting that participation in the monitoring program in Massachusetts was until 2012).Google Scholar
Arditi, L., “New Health Law: Health-Care Providers Must Register in Prescription Database,” Providence Journal, May 19, 2014, available at <http://www.providencejournal.com/news/government/20140529-new-r.i.-law-requires-health-care-providers-to-register-in-prescription-database.ece> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
Haffajee, R. L., Jena, A.B., and Weiner, S.G., “Mandatory Use of Prescription Drug Monitoring Programs,” JAMA 313, no. 9 (2015): 891-892, available at <http://doi.org/10.1001/jama.2014.18514> (last visited April 2, 2018).Google Scholar
Id.Google Scholar
“Mandated Use of Prescription Drug Monitoring Programs,” National Alliance for Model State Drug Laws (Jun. 30, 2017) at 2, available at <http://www.namsdl.org/library/FE179822-E782-AA56-9E97D5E5D9F19D7B> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
“Recent Legislative and Regulatory Trends in Prescription Monitoring Programs,” National Alliance Model State Drug Laws (Aug. 2014): at 2, available at <http://www.namsdl.org/library/D651C2DC-B73E-DC6A-C450A4863CC1F73C> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
Finklea et al., supra note 78, at 3.Google Scholar
S. Rep. No. 87-1744 (1962), reprinted in 1962 U.S.C.C.A.N. 2884, 2886.Google Scholar
Finklea et al., supra note 78, at 15.Google Scholar
Id., at 16.Google Scholar
Id., at 19.Google Scholar
Roe v. Wade, 410 U.S. 113, 154 (1973).Google Scholar
Id.Google Scholar
Id., at 165.Google Scholar
Rust v. Sullivan, 500 U.S. 173 (1991).Google Scholar
Rust v. Sullivan, 500 U.S. 173, 180 (1991).Google Scholar
See id., at 846–854.Google Scholar
See generally Haupt, C.E., “Professional Speech,” Yale Law Journal 125 (2015): 1238-1303, at 1297.Google Scholar
S.D. Codified Laws § 34-23a-10.1(1)(e)(ii) (2015).Google Scholar
See Keighley, J.M., “Physician Speech and Mandatory Ultra-sound Laws: The First Amendment’s Limit on Compelled Ideological Speech,” Cardozo Law Review 34 (2013): 2347-2405.Google Scholar
Tex. Med. Providers Performing Abortion Servs. v. Lakey, 667 F.3d 570, 578 (5th Cir. 2012); see also Haupt, supra note 96, at 1300 (discussing the mandatory ultrasound cases).Google Scholar
Stuart v. Camnitz, 774 F.3d 238, 256 (4th Cir. 2014).Google Scholar
Id.; Haupt, supra note 96, at 1300.Google Scholar
Haupt, supra note 96, at 1300.Google Scholar
Id.Google Scholar
Associated Press, “FDA Approves Abortion Pill,” Washington Post, September 28, 2000, available at <http://www.washingtonpost.com/wp-srv/aponline/20000928/apon-line115709_000.htm> (last visited May 29, 2018).+(last+visited+May+29,+2018).>Google Scholar
Lyons, K., “Proscribing Prescriptions: A Legal Analysis of State Off-Label Restrictions on Medication Abortion,” Journal of Law and Inequality: Sua Sponte (2016), available at <http://editions.lib.umn.edu/suasponte/2016/11/21/proscribing-prescriptions-a-legal-analysis-of-state-off-label-restrictions-onmedication-abortion> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
Green, M.F. and Drazen, J.M., “A New Label for Mifepris-tone,” New England Journal of Medicine 374, no. 23 (2016) 2281-2282.CrossRefGoogle Scholar
Cline v. Oklahoma Coal. for Reprod. Justice, 313 P.3d 253, 261 (Okl. 2013).Google Scholar
Id. at 261.Google Scholar
Id.Google Scholar
Id.Google Scholar
“Targeted Regulations of Abortion Providers,” Guttmacher Institute (Oct. 1, 2017), available at <https://www.guttmacher.org/state-policy/explore/targeted-regulation-abortion-providers> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
Id.Google Scholar
Fla Laws. ch. 2011-112, 2011 (codified at Fla Stat §§ 381.026, 456.072, 790.338) (2012).Google Scholar
Wollschlaeger v. Governor, Florida, 848 F.3d 1293, 1307 (11th Cir. 2017).Google Scholar
Id. at 1313 (quoting Sorrell v. IMS Health, Inc., 564 U.S. 552, 578-79 (2011)).Google Scholar
Anderson-Watts, R., “The Failure of Breast Cancer Informed Consent Statutes,” Michigan Journal of Gender and Law 14, no. 2 (2008): 201-222, at 206.Google Scholar
Id. at 215.Google Scholar
Id. at 212.Google Scholar
Nattinger, A.B., Hoffman, R.G., Shapiro, R., Gottleib, M.S., and Goodwin, J.S., “The Effect of Legislative Requirements on the Use of Breast-Conserving Surgery,” New England Journal of Medicine 335, no. 14 (1996): 1035-1040.Google Scholar
Lantz, P.M., Janz, N.K., Fagerlin, A., Schwartz, K., Liu, L., Lakhani, I., Salem, B., and Katz, S.J., “Satisfaction with Surgery Outcomes and the Decision Process in a Population-Based Sample of Women with Breast Cancer,” Health Services Research 40, no. 3 (2005): 745-768, at 753.Google Scholar
Id.Google Scholar
Id.Google Scholar
See “New York State Confidentiality Law and HIV: Public Health Law, Article 27-F Questions and Answers,” New York State Department of Health, available at <https://www.health.ny.gov/publications/9192.pdf> (last visited April 2, 2018); N.Y. Civ. Rights Law § 79-l (McKinney).+(last+visited+April+2,+2018);+N.Y.+Civ.+Rights+Law+§+79-l+(McKinney).>Google Scholar
See Webb v. United States, 249 U.S. 96 (1919) (finding that a physician could not prescribe morphine to an individual with addiction because it would not “cure” his addiction but maintain his use); United States v. Doremus, 249 U.S. 86 (1919); United States v. Behrman, 258 U.S. 280 (1922).Google Scholar
Schottenfeld, J. R., Waldman, S., Gluck, A. R., and Tobin, D. G., “Pain and Addiction in Specialty and Primary Care: The Bookends of a Crisis,” Journal of Law, Medicine & Ethics 46, no. 2 (2018): 220-238.Google Scholar
E.g., Llorente, E., “New Jersey’s New Opioid Law Raises Concerns among Doctors,” Fox News Health, May 9, 2017, available at <http://www.foxnews.com/health/2017/05/09/new-jerseys-new-opioid-law-raises-concerns-among-doctors.html> (last visited April 2, 2018) (quoting the New Jersey Attorney General arguing that “a bad doctor is worse than a street corner drug dealer – a doctor is someone who is shrouded in the public trust. A doctor has to be treated more harshly than a street drug dealer.”).+(last+visited+April+2,+2018)+(quoting+the+New+Jersey+Attorney+General+arguing+that+“a+bad+doctor+is+worse+than+a+street+corner+drug+dealer+–+a+doctor+is+someone+who+is+shrouded+in+the+public+trust.+A+doctor+has+to+be+treated+more+harshly+than+a+street+drug+dealer.”).>Google Scholar
Nilsen, E., “New Pain Prescribing Guidelines Fuel Concern over Legislating Medical Care,” Concord Monitor, June 26, 2016, available at <http://www.concordmonitor.com/doctors-talk-about-new-opioid-prescribing-rules-in-NH-2965859> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
Chaudhry, H.J., Gifford, J.D., and Hengerer, A.S., “Ensuring Competency and Professionalism through State Medical Licensing,” JAMA 313, no. 18 (2015): 1791-1792 (describing the continued importance of state medical boards in protecting modern medical standards).Google Scholar
Teegardin, C., “Doctors and the Opioid Crisis: An AJC National Investigation,” The Atlanta Journal-Constitution, December 1, 2017, available at <http://www.myajc.com/news/public-affairs/healers-dealers/wrKUc6J0p2sz4dFi3fwXJK> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
HIV and Hepatitis B — Infection Control Standards and Training, 1992 N.Y. Sess. Laws 2157 (codified at N.Y. Educ. Law § 6530(47) (McKinney 2018)).Google Scholar
“Methadone Diversion Control,” in Rettig, R.A. and Yarmolinsky, Y., eds., Federal Regulation of Methadone Treatment (Washington D.C.: National Academy Press, 1995).Google Scholar
McCabe, S.E., Teter, C.J., and Boyd, C.J., “Medical Use, Illicit Use and Diversion of Prescription Stimulant Medication,” Journal of Psychoactive Drugs 38, no. 1 (2006): 43-56.Google Scholar
See generally Kliff, S., “How Well-Intentioned Doctors Helped Create the Opioid Epidemic,” Vox, November 7, 2017, available at <https://www.vox.com/2017/11/7/16387318/doctors-helped-create-opioid-epidemic> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
Compare “Guidelines for the Chronic Use of Opioid Analgesics,” Federation of State Medical Boards of the United States (2017), available at <https://www.fsmb.org/Media/Default/PDF/Advocacy/Opioid%20Guidelines%20As%20AdopteA%20April%202017_FINAL.pdf> (last visited April 2, 2018), with “Position of the Federation of State Medical Boards: In Support of Pain Management Guidelines,” Federation of State Medical Boards of the United States (1998), available at <https://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/1998_grpol_Pain_Management_GGuideline.pdf> (last visited April 2, 2018).+(last+visited+April+2,+2018),+with+“Position+of+the+Federation+of+State+Medical+Boards:+In+Support+of+Pain+Management+Guidelines,”+Federation+of+State+Medical+Boards+of+the+United+States+(1998),+available+at++(last+visited+April+2,+2018).>Google Scholar
See Yokell, M.A., Zaller, N.D., Green, T.C., and Rich, J.D., “Buprenorphine and Buprenorphine/Naloxone Diversion, Misuse, and Illicit Use: An International Review,” Current Drug Abuse Reviews 4, no. 1 (2011): 28-41.Google Scholar
“New Limits Take Effect for Opioid Prescriptions in Ohio,” NBC4i (Aug. 31, 2017), available at <http://nbc4i.com/2017/08/31/new-limits-take-effect-for-opioid-prescriptions-in-ohio> (last visited April 2, 2018).+(last+visited+April+2,+2018).>Google Scholar
Boyd, T.H., “Cost Containment and the Physician’s Fiduciary Duty to the Patient,” DePaul Law Review 39 (1989): 131-159, at 137 n. 32.Google Scholar