State Medical Board Members' Beliefs About Pain, Addictions, and Diversion and Abuse: A Changing Regulatory Environment
Three national surveys were conducted in 1991, 1997, and 2004 to evaluate state medical board members' knowledge and attitudes about prescribing opioid analgesics for pain management. Topics addressed include perceived legality of prolonged opioid prescribing, characteristics of addiction, prevalence of medication abuse and diversion, and perceived importance and influence of medical board policy. Questions were added in 2004 to determine board members' views about law enforcement involvement in physician investigations and prosecutions. This study assesses medical regulators' current beliefs and compares the 2004 responses with previous responses to determine how knowledge and attitudes about prescribing opioids have changed in recent years. Survey results show that board members have a greater understanding of pain management issues, particularly regarding characteristics of addiction and the legality of prolonged opioid prescribing for chronic noncancer pain. During the last 15 years, there has been substantial regulatory policy development, with medical boards adopting regulations, guidelines, or policy statements to provide guidance to licensees about using opioids to treat pain. However, many board members believe that federal and state law enforcement agencies have increased criminal investigations and prosecutions of physicians. We discuss appropriate regulatory and law enforcement responses to opioid prescribing violations, and suggest crucial next steps.
Since 1991, the Federation of State Medical Boards of the United States (the Federation) and the University of Wisconsin Pain & Policy Studies Group (PPSG) have collaborated to address physicians' concerns about regulatory scrutiny.28 Interest in this topic stemmed from reports suggesting that physicians fear investigation when prescribing opioids, which can negatively affect patient care.5,7,20,42 To examine whether this fear was justified, the Federation and the PPSG cosponsored a series of national surveys of state medical board members who license and discipline physicians for unprofessional conduct, including prescribing violations.15,24 A 1991 survey24 showed that many medical regulators doubted that extended opioid prescribing for patients with chronic pain was legal and medically acceptable, especially when the patient had a history of substance abuse. In addition, board members (like others in the healthcare community) often defines "addiction" to mean "physical dependence" or "tolerance," which are normal physical responses in patients with pain being treated chronically with opioids. Confusion about these terms can lead to the perception that any patient being treated with opioids is addicted.