Achieving Balance in Federal and State Pain Policy: A Guide to Evaluation (CY 2013)
This research was designed to help ensure that people with pain who need treatment with controlled medicines are better able to have access, by identifying and assessing balance in current federal and state statutes, regulations, and other official policies. Since the inception of this project in 2000, numerous states have adopted policies to enhance safe and effective pain management while removing regulatory barriers to appropriate treatment. These policies often are modeled after balanced templates developed by the Federation of State Medical Boards. Nevertheless it is possible that new state laws and healthcare regulatory policies aimed at substance abuse could introduce undue requirements, restrictions, or ambiguities that could impede healthcare decision‐making and patient care. Examples of current policies affecting pain management are included throughout this report and, especially, in Section IX. Adoption of balanced policy responds to the continued call from international and national authoritative bodies representing legal, regulatory, and healthcare communities to promote the reduction of the non‐medical use of prescription medications while at the same time addressing inadequate treatment for debilitating pain.
Most of the policy development activities identified in this report demonstrate state governments’ willingness to cooperate and promote safe and effective pain management and avoid unduly restricting access to controlled medications for the people who need them, while taking precautions against exacerbating non‐medical use or diversion. The overall aim is a balanced drug control and healthcare regulatory environment that maintains or improves the well‐established closed distribution system of drug control and related information systems. To achieve and sustain balance in a dynamic environment, it is necessary to understand and enforce the closed distribution system, preserving the critical distinction between the many patients who use these medications for therapeutic purposes and those whose motivations and activities are outside medicine and the law. Appendix A provides an extensive list of recommended readings, of which the articles by Cicero et al., Coleman, Inciardi et al., and Joranson & Gilson are relevant to this issue.
When balance is achieved, patient care decisions can be based only on clinical circumstances, with individualized treatment approaches that are not hampered by legislative or regulatory barriers. Such an approach could help to allay the concern expressed in a recent editorial in the Journal of Pain Research:
“Why should patients with chronic pain who are prescribed necessary opioids for legitimate medical purposes endure the wrath of policy changes and resultant untreated pain due to criminality of others…?”