Drug Enforcement Administration Officials, Pain Specialists Issue Guidelines on Use of Medications
Drug Enforcement Administration officials and pain specialists on Wednesday issued guidelines on the use of pain medications to help convince physicians that they will not risk prosecution when they properly prescribe controlled substances such as OxyContin and morphine, the AP/Las Vegas Sun reports. Patricia Good, drug diversion-chief at DEA, said that the guidelines should help eliminate an "aura of fear" that "doctors who treat pain aggressively are singled out" by the agency (Neergaard, AP/Las Vegas Sun, 8/11).
The guidelines, which DEA will distribute to law enforcement agencies and physicians who apply for agency approval to prescribe controlled substances, make "clear to law enforcement authorities that even heavy use of prescription opioids can be appropriate and that the physical dependence it brings is not the same as physical addiction," the Washington Post reports.
Many physicians and pharmacists decided not to prescribe or dispense controlled substance to patients with severe pain because an earlier DEA consensus paper did not clarify the agency position on the issue and led to concerns about prosecution. Since OxyContin became more commonly used and abused in the late 1990s, the federal government has prosecuted hundreds of physicians, pharmacists and some of their employees (Kaufman, Washington Post, 8/12).
Last year, DEA arrested 50 physicians who allegedly improperly prescribed narcotics or other controlled substances (Rubin, USA Today, 8/12). However, Good, who helped write the guidelines, said that "there are many misconceptions about the DEA's role and even the DEA's fundamental beliefs about the use of prescription opioids."
Russell Portenoy of Beth Israel Medical Center, who also helped write the guidelines, added, "What this document does is make clear (that) we in pain management and DEA are on the same page and that we're willing to endorse the same principles."
David Joranson, director of pain studies at University of Wisconsin, who also helped write the guidelines, said, "We hope this is a step in the right direction, to reverse an increasingly unfriendly environment for pain management" (Washington Post, 8/12). According to Portenoy, about 40% of patients with pain related to terminal illnesses such as cancer and AIDS, as well as those with chronic pain, do not receive adequate pain medication (USA Today, 8/12).
The guidelines ask physicians to ensure that their patients do not abuse pain medications or engage in "doctor-shopping to collect narcotics for illicit sales," the Post reports (Washington Post, 8/12). The guidelines ask physicians to:
- Include in the medical records of first-time patients medical histories, physical exam results, pain assessments and treatment plans and add reassessments to the records after subsequent visits;
- Include evidence in medical records that they have evaluated the nature and impact of the pain experienced by patients, earlier treatments they have taken and their alcohol- and drug-use histories; and
- Examine patients for indications of pain medication abuse, such as an unwillingness to provide information on previous physicians; requests for higher doses of pain medications, early refills or specific treatments; deterioration in function at home or work; illegal conduct, such as theft and prescription forgery; and repeated loss of prescriptions (AP/Las Vegas Sun, 8/11).