Health Policy & Quality Management



Health Policy & Quality Management

Introduction

Insufficient pain management is a significant public health concern and adequate relief depends on access to a variety of treatment options, including the appropriate use of controlled substances when the pain is of moderate or severe intensity. U.S. federal and state controlled substances policies and state medical practice policies govern physician prescribing, dispensing, and administering of controlled substances, including opioid analgesics. Controlled substances laws are designed primarily to control the diversion and abuse of drugs, but federal laws (i.e., the Controlled Substances Act and the Code of Federal Regulations) recognize that opioid analgesics are necessary for the relief of pain and that their availability for medical purposes must be ensured.

Discussion

Federal law also acknowledges the value of controlled substances to public health and the Food and Drug Administration approves controlled substances as safe and effective when used under medical supervision. Under federal law, licensed physicians can prescribe controlled substances for legitimate medical purposes when in the usual course of professional practice ; the policy also affirms that physicians are responsible for the proper prescribing and dispensing of controlled substances. State controlled substances policy has the potential to conform to federal law by recognizing the dual purpose of drug control policy, which emphasizes the public health importance of prescription medications as well as the need to provide security against their diversion and abuse. However, the necessity of balancing the medical utility of prescription medications with drug control may not be adequately represented in state controlled substances laws, which often place primary emphasis on establishing security requirements to protect the public.

Medical practice, including the professional use of opioid analgesics for pain relief and palliative care, is regulated solely by state policies. The policies that govern medical practice at the state level include medical and pharmacy practice legislation and regulations, as well as regulatory boards' guidelines or policy statements, and are defined. The Federation of State Medical Boards of the U.S. (the Federation) offers a model statute called the Modern Medical Practice Act (MMPA) to help guide the creation of medical practice acts; the MMPA defines medical practice to include the treatment of pain. As such, professional practice policy can place the diagnosis and treatment of pain within the ordinary purview of medicine. In addition, medical practice policy can conform to national authoritative sources, such as federal law , the Uniform Controlled Substances Act (UCSA) , and the Federation , by clearly regarding opioid prescribing as a legitimate professional practice.

Over the last 15 years, states have developed health policies with the intention to directly enhance pain management and to relieve licensees' concerns about regulatory oversight when prescribing controlled substances in large quantities or for extended periods. During this time there has been a substantial increase in the number of policies relevant to the use of controlled substances to treat pain, from a total of six policies in 1989 to 91 policies in 2003. Such policies include Intractable Pain Treatment Acts (IPTAs) and medical board regulations, ...