The apparent reason is that these patients lack either access to other programs or physicians who are willing to use opioid analgesics, especially in high doses. However, opioid analgesics, including methadone, may be prescribed for patients with pain, including intractable pain, by any physician who can prescribe controlled substances. Dr. Tennant says his programs are treating approximately 200 chronic pain patients, not for addiction, but for pain. Although the California IPTA endorsed opioid treatment for intractable pain, Dr. Tennant asserts there remains a strong reluctance among physicians to prescribe the quantities of opioids needed by patients with severe chronic pain. Dr. Tennant contends that these patients are very ill, disabled, and have limited funds.
Several questions are obvious.
It appears so. Most pain patients who take opioids regularly for chronic pain would meet this outdated and incorrect definition of opioid dependence. It would have clarified matters if the committee had simply said that the federal regulations should establish a clear distinction between the treatment of opioid dependence and the treatment of pain. The IOM proposal to prohibit, by federal regulation, the future admission of chronic pain patients to addiction treatment programs seems to be a reasonable policy approach to differentiate the treatment of addiction from the treatment of chronic pain. The policy would reserve needed treatment slots for addicts while endorsing the treatment of chronic pain patients in the general healthcare system.