The CSA does not restrict a clinician's medical decision about which drug to prescribe, in what amounts, or for what duration, although it does prohibit physicians from prescribing opioids to maintain narcotic addiction unless the physician is separately registered to treat addiction. State laws vary greatly, and many restrict or regulate the prescribing of opioids in the treatment of pain in ways that Federal law does not. A 1990 revision of the Uniform Controlled Substances Act addresses the legitimate use of controlled substances by recognizing that the prescribing, administering, and dispensing of opioid analgesics for intractable pain is part of professional medical treatment. Each State legislature has received the revision from the Uniform Law Commissioners. The panel recommends that laws and regulatory policies aimed at diversion control not hamper the appropriate use of opioid analgesics for cancer pain .
Clinicians are responsible for knowing how controlled substances are regulated in their States.
Cost and Reimbursement for Pain Management Determining the overall cost of pain management is difficult because it generally is not separated from other treatment costs, but rather is included as part of the patient's stay in the hospital or an outpatient visit. Reimbursement policies of third-party payers for pain management differ substantially, and many people with cancer are uninsured or underinsured. For those who are insured, reimbursement policies may favor the use of more expensive pain management modalities over less expensive ones. Medicare, for example, does not reimburse for outpatient oral analgesics but will reimburse for pain management in an inpatient facility. Reimbursement policies on pain management should be studied to enable further understanding of those that promote the most cost effective pain management .