Improving Availability of Opioid Pain Medications: Testing the Principle of Balance in Latin America
The principle of balance began to take shape in Wisconsin in the late 1970s due in part to an intergovernmental and multidisciplinary policy environment. I was administrator of the Wisconsin Controlled Substances Board (CSB), a state regulatory body established by the Wisconsin Legislature to manage the state's controlled substances policy. The CSB was unique among state agencies in that it was independent of any department, and its membership, by law, included a pharmacologist and a psychiatrist—recognition that drug regulatory decisions have scientific and clinical implications. I had previously been coordinator of a drug abuse treatment program where I had seen how "script doctors" could contribute to the drug abuse problem, and realized there was a lack of coordination among the government agencies that were supposed to address the problem. In response, the CSB developed a program to reduce the abuse of prescription controlled substances in the state. The program was unique in several ways. Rather than establish additional prescription requirements as some states had, we formalized cooperation between a number of government regulatory agencies, including the CSB, Medicaid, the Medical and Pharmacy Examining Boards, and the US Drug Enforcement Administration. We developed a systematic approach to analyzing and mapping data from a number of sources to identify the sources of diversion, including pharmacy thefts and physicians and pharmacists who prescribed or dispensed improperly. By the mid-1980s, the program successfully had reduced the illicit availability of prescription controlled substances in the state, and it had been recognized as an innovative model.1 In 1981, the Legislature officially added the diversion prevention and control program to the CSB's permanent responsibilities.1