Commentary on Jung and Reidenberg’s “Physicians Being Deceived”: Aberrant Drug‐Taking Behaviors: What Pain Physicians Can Know (or Should Know)

Jung and Reidenberg have once again touched a nerve in their piece: Physicians Being Deceived. Always with a knack for highlighting key controversies in the medico-legal arena, they are to be applauded for this contribution that brings data to bear on an issue that has heretofore been subject to changing legal and regulatory currents without being informed by science. Physicians have more and more been given back the responsibility for ferreting out addicted and drug dealing patients. Early intractable pain laws offered pain physicians protections when they prescribed opioids, but limited these protections by excluding known substance abusers or those who should be known to be substance abusers [1]. It was considered progress by the pain management community when the wording of such laws began changing, coinciding with the recognition that pain management with opioids in those with substance abuse is feasible, can be safe, and is an ethical imperative in some situations. However, with the growth of prescription drug abuse, the pressure to detect lying has been rising for prescribing physicians.And these patients do lie. Jung and Reidenberg point out that this lying is nearly impossible to detect given most physicians' truth bias. Physicians are taught that patients come in seeking help and are approaching them in a good faith fashion to enlist such help. When people lie to doctors to obtain more opioids, not all lying is created equally nor are they equal in terms of the bad faith …