A recurring theme in the debate over adequate pain management is the extent to which physicians’ fear of criminal investigation and prosecution has set up barriers to appropriate dispensing of pain relief to patients. While there have been several studies looking at the regulatory environment and its effect on physicians’ prescribing practices and the treatment of pain, there has been scant research on the probability of investigation or prosecution of physicians who aggressively prescribe opioids for pain management.

To understand whether physicians’ fear of investigation or prosecution is based on a realistic assessment of risk, the authors surveyed chief prosecutors in four states (Maryland, Connecticut, Oregon, and Washington), all of which have varying degrees of focus, prosecutorial culture, and regulatory attitudes toward this issue.