Influence of Drug Control Policy on Pain Medicine
"Opioid medications also have a potential for abuse (a discussion of this important issue is in the Executive Summary and Section III of the Evaluation Guide 2013). Consequently, opioid analgesics and the healthcare professionals who prescribe, administer, or dispense them are regulated pursuant to federal and state controlled substances laws, as well as under state laws and regulations that govern professional practice.70;71 Such policies are intended to prevent illicit trafficking, drug abuse, and substandard practice related to prescribing and patient care. However, in some states these policies go well beyond the usual framework of controlled substances and professional practice policy, and can negatively affect legitimate healthcare practices and create undue burdens for practitioners and patients,72-76 resulting in interference with appropriate pain management.
"Examples of such policy language include:
" Limiting medication amounts that can be prescribed and dispensed for every patient;
" Unduly restricting the period for which prescriptions are valid;
" Unconditionally denying treatment access to patients with pain who also have a history of substance abuse;
" Requiring special government-issued prescription forms only for a certain class of medications;
" Requiring opioids to be a treatment of last resort regardless of the clinical situation;
" Using outdated definitions that confuse physical dependence with addiction; and
" Defining 'unprofessional conduct' to include 'excessive' prescribing, without defining the standard or criteria under which such a determination is made."