Achieving Balance in State Pain Policy: A Progress Report Card (CY 2013)
This report focuses on the extent that drug control and medical and pharmacy practice policies contain language that can potentially enhance or impede pain management. A research methodology was developed to grade each state based on the content of its policy that can affect treatment of patients’ pain. State grades are presented for 2006-2008, 2012, and 2013 to allow an understanding of policy change over time.
This report concludes that state pain policies are becoming more balanced, even when compared to the last evaluation in 2012. Since 2012:
- Twenty-four states changed policies or adopted new policies containing language that fulfilled at least one evaluation criterion, and in five of those states the policy change was sufficient to improve their grade;
- Alabama and Idaho achieved an A in 2013, and join Georgia, Iowa, Kansas, Maine, Massachusetts, Michigan, Montana, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin as having the most balanced pain policies in the country;
- Idaho showed the largest grade improvement between 2008 and 2013, increasing a full grade level;
- 96% of states now have a grade above a C (based on grades calculated in 2000), compared to 88% in 2008; and
- No state’s grade decreased since 2012 or even since 2006.
The policy improvement that occurred between 2012 and 2013 was largely the result of: (1) adopting policies to encourage appropriate pain management, palliative care, or end-of-life care, and (2) state legislatures or regulatory agencies repealing restrictive or ambiguous policy language.
The momentum of positive policy change documented in 2006 seems to be continuing. This improvement supports the conclusion that government and regulatory agencies continue to appreciate the need to encourage appropriate treatment of pain without creating barriers to such treatment. Legislatures are additionally adopting laws to prevent drug abuse and diversion at the state level that have tended to eschew requirements that would interfere with legitimate medical practice and patient care. In fact, many of these recent policies contain an objective statement related to both reducing the non-medical use of prescription medication and maintaining their availability for healthcare purposes, which reflects the conceptual framework used for this policy evaluation.
Experience around the country is showing that a valuable state governmental mechanism to achieve more balanced policy is the use of task forces, advisory councils, and summit meetings to examine the need for changes in state pain policy. Many states now face the challenge not only of adopting positive policies, but of removing restrictive language from legislation or regulations. Even for states that have achieved an A, there remains the potential for additional policy activity (however well-intentioned) that might introduce potentially restrictive requirements or limitations. Continued efforts to enhance pain management through state policy must avoid unintended restrictions or ambiguities that could interfere with legitimate practice.
This Progress Report Card, used in conjunction with the Evaluation Guide 2013, provides a framework for deciding which policies should be addressed, as well as language from other states to guide the development of new and more balanced policies related to the provision of pain care services. Balance in pain policy can be achieved and maintained if policymakers, healthcare professionals, and regulatory agencies work together and take advantage of available policy resources. In this way, a more positive legislative, regulatory, and practice environment can be established for the relief of pain in all patients, including those who are challenged by cancer, HIV/AIDS, sickle-cell anemia, and other painful conditions.