Providing Relief to Those in Pain: A Retrospective on the Scholarship and Impact of the Mayday Project

Post L. “Pain: Ethics, Culture, and Informed Consent to Relief,” Journal of Law, Medicine & Ethics, 24, no. 4 (1996): 348–59; Bonham VL , “Race, Ethnicity, and Pain Treatment: Striving to Understand the Causes and Solutions to Disparities in Pain Treatment,” Journal of Law, Medicine & Ethics, 29, no. 1 (2001): 52–68; Hoffmann D.E. Tarzian A.J. , “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain,” Journal of Law, Medicine & Ethics, 29, no. 1 (2001): 13–27.

Pisano D. , “Controlled Substances and Pain Management: Regulatory Oversight, Formularies, and Cost Decisions,” Journal of Law, Medicine & Ethics, 24, no. 4 (1996): 310–16; Hoffmann D.E. , “Pain Management and Palliative Care in the Era of Managed Care: Issues for Health Insurers,” Journal of Law, Medicine & Ethics, 26, no. 4 (1998): 267–89; Jost T. , “Public Financing of Pain Management: Leaky Umbrellas and Ragged Safety Nets,” Journal of Law, Medicine & Ethics, 26, no. 4 (1998): 290–307.

Alpers A. , “Criminal Act or Palliative Care? Prosecutions Involving Care of Dying,” Journal of Law, Medicine & Ethics, 26, no. 4 (1998): 308–31; Furrow B.R. , “Pain Management and Provider Liability: No More Excuses,” Journal of Law, Medicine & Ethics, 29, no. 1 (2001): 28–51; Shapiro R. , “Health Care Providers' Liability Exposure for Inappropriate Pain Management,” Journal of Law, Medicine & Ethics, 24, no. 4 (1996): 360–64; Johnson S. , “Legal and Regulatory Issues in Pain Management,” Journal of Law, Medicine & Ethics, 26, no. 4 (1998): 265–66.

Brushwood D.B. , “From Confrontation to Collaboration: Collegial Accountability and the Expanding Role of Pharmacists in the Management of Chronic Pain,” Journal of Law, Medicine & Ethics, 29, no. 1 (2001): 69–93.

Portenoy R. , “Opioid Therapy for Chronic Nonmalignant Pain: Clinicians' Perspective,” Journal of Law, Medicine & Ethics, 24, no. 4 (1996): 296–309; Martino A. , “In Search of a New Ethic for Treating Patients with Chronic Pain: What Can Medical Boards Do?,” Journal of Law, Medicine & Ethics, 26, no. 4 (1998): 332–49; Haddox J.D. Aronoff G. , “Commentary: The Potential for Unintended Consequences from Public Policy Shifts in the Treatment of Pain,” Journal of Law, Medicine & Ethics, 26, no. 4 (1998): 350–52; Johnson S. , “Introduction: Relieving Unnecessary Treatable Pain for the Sake of Human Dignity,” Journal of Law, Medicine & Ethics, 29, no. 1 (2001): 11–12.

Project on Legal Constraints on Access to Effective Pain Relief, “The Pain Relief Act,” Journal of Law, Medicine & Ethics, 24, no. 4 (1996): 317–18; Johnson S. , “Disciplinary Actions and Pain Relief: Analysis of the Pain Relief Act,” Journal of Law, Medicine & Ethics, 24, no. 4 (1996): 319–27; Ralston D. , “Pain Management: Texas Legislative and Regulatory Update,” Journal of Law, Medicine & Ethics, 24, no. 4 (1996): 328–37; Hyman C. , “Pain Management and Disciplinary Action: How Medical Boards Can Remove Barriers to Effective Treatment,” Journal of Law, Medicine & Ethics, 24, no. 4 (1996): 338–43; Joranson D.E. Gilson A.M. , “Improving Pain Management through Policy Making and Education for Medical Regulators,” Journal of Law, Medicine & Ethics, 24, no. 4 (1996): 344–47.

The first two years of the project were also supported by the Emily Davie and Joseph S. Kornfeld Foundation.

Skelly F.J. , “Fear of Sanctions Limits Prescribing of Pain Drugs,” American Medical News, August 15, 1994, at 19; Portenoy R.K. , “Opioid Therapy for Chronic Non-Malignant Pain: A Review of the Critical Issues,” Journal of Pain and Symptom Management, 11 (1996): 203–17, at 204; New York Public Health Council, Breaking Down the Barriers to Effective Pain Management, Recommendations to Improve the Assessment and Treatment of Pain in New York State (January 1998).

Johnson , supra note 6, at 321.

Johnson , supra note 6.

Ralston , supra note 6.

Joranson Gilson , supra note 6.

Martino , supra note 5.

Haddox Aronoff , supra note 5.

Johnson , supra note 6.

Hyman , supra note 6, at 340.

Id. at 341.

See id. at Table 1. As of 1996, California, Missouri, Nevada, North Dakota, Oregon, and Texas had enacted statutes with provisions preventing disciplinary action against physicians and/or osteopathic physicians. None of these statutes provided disciplinary protection for other health care professionals.

Furrow B. , Health Law, Practitioner Treatise Series, 2nd ed. (St. Paul: West Publishing Co. 2000): § 3–23(a).

See, e.g., Mo. Rev. Stat. § 334.106 (1995) (“The provisions of … this section shall not apply to those persons being treated by a physician for chemical dependency because of their use of controlled substances not related to the therapeutic purposes of treatment of intractable pain.”). See also N.D. Cent. Code § 19–03.3–05 (1995) (“This chapter does not authorize a physician to prescribe or administer controlled substances to a person the physician knows is using controlled substances for nontherapeutic purposes.”).

The Federation of State Medical Boards is composed of medical boards from the United States, the District of Columbia, Puerto Rico, Guam, the Virgin Islands, and the Commonwealth of the Northern Mariana Islands, and thirteen state boards of osteopathic medicine. Along with the National Board of Medical Examiners, the Federation created and administers uniform testing for medical licensing. The Federation also developed and administers assessment tools for evaluation of ongoing clinical performance and maintains the Federation Data Center, a nationally recognized system for collecting, recording, and distributing to state medical boards and other appropriate agencies data on disciplinary actions taken against physicians and physician assistants by the boards and other governmental authorities. The Federation's mission is the continual improvement in the quality, safety, and integrity of health care through the development and promotion of high standards for physician licensure and practice. Federation of State Medical Boards, About Us, at <http://www.docinfo.org/alp_about_us.htm> (last visited February 7, 2003); Federation of State Medical Boards, FSMB Facts, at <http://www.fsmb.org/aboutus.htm> (last visited February 7, 2003).

Federation of State Medical Boards, Model Guidelines for the Use of Controlled Substances for the Treatment of Pain (Euless, Texas: Federation of State Medical Boards, 1998), available through <http://www.fsmb.org>.

Federation of State Medical Boards, Position of the Federation of State Medical Boards in Support of Adoption of Pain Management Guidelines (Euless, Texas: Federation of State Medical Boards of the United States, 2000), available at <http://www.medsch.wisc.edu/painpolicy/domestic/FSMBwp.htm>. (“The Federation promotes a non-legislative approach in improving the regulation of physicians prescribing controlled substances in the treatment of pain. Legislative action may hinder the appropriate management of pain by physicians through unnecessary requirements and could supplant the authority of state medical boards to improve the quality of care available to patients within their jurisdictions. Thus, state medical boards should be proactive in the promotion of pain management policy initiatives to preclude legislative intervention.”).

Ariz. Rev. Stat. § 13–3412.01 (2002); Cal. Bus & Prof Code § 2241.5 (2003); Colo. Rev. Stat. §§ 12-36-117, 18-18-308 (2002); Fla. Stat. § 458.326 (2002); Mass. Gen. Laws ch. 94C § 9 (2003); Mich. Comp. Laws §§ 333.16204a, 333.16204b, 333.16204c, 333.16204d (2002); Minn. Stat. § 152.125 (2002); Mo. Rev. Stat. §§ 334.105–334.107 (2002); Neb. Rev. Stat. §§ 71–2418, 71–2419 (2002); Nev. Rev. Stat. §§ 630.3066, 630.135 (2002); N.H. Rev. Stat. Ann. § 318-B:10 (2002); N.M. Stat. Ann. §§ 24–2D-1 to 24–2D-6 (2002); N.D. Cent. Code §§ 19–03.3–01 to 19–03.3–06 (2002); Ohio Rev. Code Ann. § 4731.052 (2002); Okla. Stat. tit. 63 § 2–551 (2003); Or. Rev. Stat. §§ 127.800–127.897 (2001); R.I. Gen. Laws §§ 5–37.4–1 to 5.37.4–3 (2001); Tenn. Code Ann. §§ 63-6-1101 to 63-6-1109 (2002); Tex. Rev. Civ. Stat. Ann. § 4495c (2002); Va. Code Ann. § 54.1–3408.1 (2002); Wash. Rev. Code § 69.50308 (2002); W Va. Code §§ 30–3A-1 to 30–3A-4 (2002); Wis. Stat. §§ 961.001 and 961.38 (2002). See also Pain & Policy Studies Group, University of Wisconsin Comprehensive Cancer Center, Data-base of State Laws, Regulations and Other Official Governmental Policies, at <http://www.medsch.wisc.edu/painpolicy/matrix.htm> (last updated November 5, 2002).

Id. See, e.g., Ohio Rev. Code. Ann. § 4731.052 (2001) (“A physician who treats intractable pain by managing it with dangerous drugs is not subject to disciplinary action by the board under section 4731.22 of the Revised Code solely because the physician treated the intractable pain with dangerous drugs. The physician is subject to disciplinary action only if the dangerous drugs are not prescribed, furnished, or administered in accordance with this section and the rules adopted under it.”).

Johnson , supra note 6; Project on Legal Constraints on Access to Effective Pain Relief, supra note 6; N.M. Stat. Ann. §§ 24–2D-1 to 24–2D-6 (2002).

Code W. Va. §§ 30–3A-1 to 30–3A-4 (2002).

Nebr. Rev. Stat. §§ 71–2418, 71–2419 (2002).

Tex. Rev. Civ. Stat. Ann.S 4495c (2002).

Ohio Rev. Code. Ann. § 4731.052(C) (2002).

Hyman , supra note 6, at 341.

Pain & Policy Studies Group, supra note 24.

Gilson A.M. Joranson D.E. Maurer M.A. , “Improving State Medical Board Pain Policies: Influence of a Model,” Journal of Law, Medicine & Ethics, 31, no. 1 (2003): 119–29; See also Joranson D.E. , “Pain Management, Controlled Substances', and State Medical Board Policy: A Decade of Change,” Journal of Pain and Symptom Management, 23, no. 2 (2002): 138–47, at 144.

Hoffmann D.E. Tarzian A.J. , “Achieving the Right Balance in Oversight of Physician Opioid Prescribing for Pain: The Role of State Medical Boards,” Journal of Law, Medicine & Ethics, 3, no. 1 (2003): 21–40.

Or. Rev. Stat. §§ 127.800 to 127.897 (1995).

Two of the articles in this symposium address the OxyContin issue. See Hoffmann Tarzian , supra note 35; Noah L. , “Challenges in the Federal Regulation of Pain Management Technologies,” Journal of Law, Medicine & Ethics, 31, no. 1 (2003): 55–74.

Brushwood D.B. , “Maximizing the Value of Electronic Prescription Monitoring Programs,” Journal of Law, Medicine & Ethics, 31, no. 1 (2003): 41–54.

Noah , supra note 37.

Ziegler S.J. Lovrich N.R. Jr. , “Pain Relief, Prescription Drugs, and Prosecution: A Four-State Survey of Chief Prosecutors,” Journal of Law, Medicine & Ethics, 31, no. 1 (2003): 75–100.

Lazarus J.B. Downing B. , “Monitoring and Investigating Certified Registered Nurse Practitioners in Pain Management,” Journal of Law, Medicine & Ethics, 31, no. 1 (2003): 101–18.

For example, ASLME, Ben Moulton, and Mayday Scholar Diane Hoffmann conducted the Connecticut Statewide Pain Management Study, a two-year project funded by the Donaghue Medical Research Foundation. The purpose of the study was to develop baseline data on the adequacy of pain treatment in the state of Connecticut and to use the data as a basis for generating interventions and recommendations for further research to address the problem of undertreatment of pain in the state. Based on the findings from the Donaghue grant, the following were published: Tarzian A. David S. Hoffmann D. , “Management of Cancer-Related and Noncancer-Related Chronic Pain in Connecticut: Successes and Failures,” Connecticut Medicine, 66 (2002): 683–89; Hoffmann D. Lazzarini Z. Moulton B. , “Constraints to Prescribing Medications for Pain Treatment in Connecticut: Part I,” The Pain Clinic, 4 (2002): 28–35; Hoffmann D. Tarzian A. , “Third Party Reimbursement Practices and Their Influence on Pain Management in Connecticut: Part I,” The Pain Clinic, 4 (2002): 11–16.