Physicians Criticize DEA Revision of Pain Medication Guidelines
The presidents of the American Pain Society, the American Academy of Pain Medicine and the American Society of Addiction Medicine sent the Drug Enforcement Administration an "unusual" joint letter criticizing recent revisions to guidelines for prescribing pain medications, the Washington Post reports.
In August, DEA posted on its Web site guidelines that "were the result of two years of discussion and negotiation between pain specialists and DEA" and "were embraced by many doctors as a breakthrough in resolving a deepening conflict between law enforcement and pain-management practitioners," the Post reports. However, DEA two months later took the guidelines down, posting a statement that said they were inaccurate and did not represent a policy statement by the agency (Kaufman, Washington Post, 12/21). The original guidelines asked 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 physicians 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 (California Healthline, 10/21).
DEA's new guidelines say that doctors who prescribe large doses of opioid painkillers to patients for long periods of time could lead to an agency investigation, the Post reports. Further, DEA said an investigation could be opened on the suspicion that a physician is "diverting controlled drugs" or to ensure a physician is not conducting "improper activity," according to the Post.
In the letter, APS President Dennis Turk, AAPM President Samuel Hassenbusch and ASAM President Lawrence Brown called DEA's move "an unfortunate step backward" and a return to "an adversarial relationship between (doctors) and the DEA." The presidents added that the new DEA guidelines could threaten their ability to provide adequate patient care. "Reading that the government can investigate merely on suspicion that the law is being violated will send chills down the spine of practitioners who are treating patients with (narcotic painkillers) and will certainly contribute to the undertreatment or nontreatment of moderate to severe chronic pain," the letter says.
DEA spokesperson Bill Grant said the agency "wishes to reassure the public that the withdrawal of the August (statement) does not represent any change in DEA's investigative emphasis or approach," adding, "Physicians acting in good faith and in accordance with established medical norms should remain confident that they may continue to dispense appropriate pain medications." Grant also said DEA is developing a process to allow input from the medical community to refine the policy (Washington Post, 12/21).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.