Improving Pain Management through Policy Making and Education for Medical Regulators

Hill C.S. , “The Negative Influence of Licensing and Disciplinary Boards and Drug Enforcement Agencies on Pain Treatment with Opioid Analgesics,” Journal of Pharmaceutical Care in Pain and Symptom Control, 1 (1993): 43–62; Max M.B. , “Improving Outcomes of Analgesic Treatment: Is Education Enough?,” Annals of Internal Medicine, 113 (1990): 885–89; “Cops and Doctors: Drug Busts Hamper Pain Therapy,” Journal of NIH Research, 4, no. 5 (1992): 27–28; Portenoy R.K. , “Chronic Opioid Therapy in Nonmalignant Pain,” Journal of Pain and Symptom Management, 5 (1990): 46–62; Turk D.C. Brody M.C. , “What Position Do APS's Physician Members Take on Chronic Pain Opioid Therapy?,” American Pain Society Bulletin, 2, no. 2 (1992): 1–5; Turk D.C. Brody M.C. Okifuji E.A. , “Physicians' Attitudes and Practices Regarding the Long-Term Prescribing of Opioids for Non-Cancer Pain,” Pain, 59 (1994): 201–08; and Weissman D.E. Joranson D.E. Hopwood M.B. , “Wisconsin Physicians' Knowledge and Attitudes About Opioid Analgesic Regulations,” Wisconsin Medical Journal, 90 (1991): 671–75.

Joranson D.E. , “Opioids for Chronic Cancer and Non-Cancer Pain: A Survey of State Medical Board Members,” Federation Bulletin: The Journal of Medical Licensure and Discipline, 79, no. 4 (1992): 15–49.

Von Roenn J.H. , “Results of Physicians' Attitudes Toward Cancer Pain Management Survey,” Proceedings of American Society of Clinical Oncology, 10 (1991): 326.

Portenoy R.K. , “Opioids for Chronic Nonmalignant Pain: A Review of the Critical Issues,” Journal of Pain and Symptom Management, 5 (1996): 203–17; Portenoy R.K. Payne R. , “Acute and Chronic Pain,” in Lowinson J.H. Ruiz P. Millman R.B. , eds., Comprehensive Textbook of Substance Abuse (Baltimore: Williams and Wilkins, 3rd ed., 1997): In press.

The following state medical boards have adopted guidelines: Alabama State Board of Medical Examiners, Pain Control Policy (1994); Alaska State Medical Licensing Board, Guidelines for Prescribing Controlled Substances (June 1993); Arizona Board of Medical Examiners, “Guidelines for Prescribing Controlled Substances for Intractable Pain,” Bomex Basics, Summer (1991): 1–2; Medical Board of California, “A Statement by the Medical Board,” Action Report, 50 (1994): 4–5; Colorado Board of Medical Examiners, Guidelines for Prescribing Controlled Substances for Intractable Pain (May 1996); Florida Board of Medicine, “Practice and Regulatory Guidelines,” Management of Pain Using Dangerous Drugs and Controlled Substances, Oct. 25 (1996): 5–7; Georgia Composite State Board of Medical Examiners, Management of Prescribing with Emphasis on Addictive or Dependence Producing Drugs (1991); Idaho State Board of Medicine, Guideline: Prescribing Opioids for Chronic Pain (1995); Maryland Board of Physician Quality Assurance, “Prescribing Controlled Drugs,” Maryland Board of Physician Quality Assurance Newsletter, 4, no. 1 (1996): 1–3; Massachusetts Board of Registration in Medicine, “Prescribing Practices Policy and Guidelines Adopted,” News, 4 (1989): 1–2; Minnesota Board of Medical Examiners, “Prescribing Within a Range of Reasonableness,” Minnesota Board of Medical Examiners Update, Fall (1988): 1–2, 5; Montana Board of Medical Examiners, Management of Chronic Pain: Statement on the Use of Controlled Substances in the Treatment of Intractable Pain, at 3–4 (Mar. 1996); North Carolina Medical Board, Management of Chronic Non-Malignant Pain (Sept. 1996); Oregon Board of Medical Examiners, Statement of Philosophy: Appropriate Prescribing of Controlled Substances (May 1991); Stasney C.R. Hill C.S. , “Pain Control and the Texas State Board of Medical Examiners,” Texas State Board of Medical Examiners Newsletter, Spring/Summer (1993): 1; Utah Medical Association, A Guide to Prescribing Controlled Substances in Utah (1987); Washington Medical Quality Assurance Commission, Guidelines for Management of Pain (Apr. 1996); and Wyoming Board of Medicine, “Pitfalls of Prescribing Controlled Substances,” Wyoming Board of Medicine's Newsletter, Spring (1993).

See Joranson , supra note 2, at 31–32.

Oregon Board of Medical Examiners, supra note 5, at 1.

Medical Board of California, “New Easy Guidelines on Prescribing,” Action Report, 51 (1994): 1, 8.

A drug holiday is a decision by a physician to stop the use of a prescribed drug in an effort (1) to determine whether it is still necessary and (2) to reassess a patient's pain.

Triplicate drugs require practitioners to use special government-issued prescription forms, which can be either single, duplicate, or triplicate copy.

Medical Board of California, “Statement by the Medical Board,” Action Report, 50 (1993): At 4–5.

“California Sponsors Pain Summit; Maryland Fends Off New Regulations,” American Pain Society Bulletin, 4, no. 3 (1994): 11–12.

California Medical Board, supra note 8.

California Medical Board, “A Statement by the Medical Board: Prescribing Controlled Substances for Pain,” Federation Bulletin: The Journal of Medical Licensure and Discipline, 81, no. 3 (1994): 203–05; California Medical Board, “Guideline for Prescribing Controlled Substances for Intractable Pain,” Action Report, 51 (1994): 1, 8; and American Pain Society, “APS OKs California Pain Treatment Guidelines,” American Pain Society Bulletin, 5, no. 2 (1995): 20–21.

See American Pain Society, id.

Board of Registered Nursing, “Pain Management Policy. Summit on Effective Pain Management: Removing Impediments to Appropriate Prescribing,” at 42 (1994). California State Board of Pharmacy, “Dispensing Controlled Substances for Pain: A Statement of the California State Board of Pharmacy,” Health Notes, (1996): 4–5.

Florida Board of Medicine, supra note 5.

North Carolina Medical Board, supra note 5.

Washington Medical Quality Assurance Commission, Management of Chronic Non-Malignant Pain (Seattle: Department of Health, Apr. 1996).

American Academy of Pain Medicine and American Pain Society, “The Use of Opioids for the Treatment of Chronic Pain. A Consensus Statement from the American Academy of Pain Medicine and the American Pain Society” (1997).

Washington v. Glucksberg, 117 S. Ct. 37 (1996) (granting cert.); and Quill v. Vacco, 117 S. Ct. 36 (1996) (granting cert.).

American Medical Association, An Act Concerning the Administration of Controlled Substances to Persons Experiencing Intractable Pain (1996).

Joranson D.E. , “State Pain Commissions: New Vehicles for Progress?,” American Pain Society Bulletin, 6, no. 1 (1996): 7–9.

Faculty included Dahl June L. , Ph.D. Brady Albert , M.D. David Haddox J. , D.D.S., M.D. Savage Seddon M.D., and Joranson David M.S.S.W.

North Carolina Medical Board, supra note 5; and Alabama State Board of Medical Examiners, 540-X-4-.08, at 4-30-4-32 (Mar. 1995).