Between a rock and a hard place: Can physicians prescribe opioids to treat pain adequately while avoiding legal sanction?

Kelly K. Dineen, James M. DuBois

Research output: Contribution to journalArticle

18 Scopus citations


Prescription opioids are an important tool for physicians in treating pain but also carry significant risks of harm when prescribed inappropriately or misused by patients or others. Recent increases in opioid-related morbidity and mortality has reignited scrutiny of prescribing practices by law enforcement, regulatory agencies, and state medical boards. At the same time, the predominant 4D model of misprescribers is outdated and insufficient; it groups physician misprescribers as dated, duped, disabled, or dishonest. The weaknesses and inaccuracies of the 4D model are explored, along with the serious consequences of its application. This Article calls for development of an evidence base in this area and suggests an alternate model of misprescribers, the 3C model, which more accurately characterizes misprescribers as careless, corrupt, or compromised by impairment.

Original languageEnglish (US)
Pages (from-to)7-52
Number of pages46
JournalAmerican Journal of Law and Medicine
Issue number1
Publication statusPublished - Jan 1 2016
Externally publishedYes


All Science Journal Classification (ASJC) codes

  • Health(social science)
  • Law

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