More than 40 states have enacted pain management guidelines or legislation. An equal number have created laws or regulations that protect physicians who prescribe therapeutic doses of oral narcotics for long-term, chronic, disabling pain. However, experts advise residents to familiarize themselves with their state s controlled substances laws and keep adequate documentation. As a resident, you also need to be aware of logistical barriers to adequate pain control. Insurance companies may limit reimbursement for pain management, and pharmacists may be reluctant to fulfill prescriptions.
Studies show that some patients have difficulty accessing narcotics at their local pharmacies.
Holly Mattix, ACP ASIM Associate, a renal fellow at Massachusetts General Hospital and Chair of the College s Council of Associates, recalled treating a patient who was in extreme pain from calciphylaxis. She had been using oxycodone so frequently her insurance company refused to pay. Dr. Mattix prescribed morphine. But five pharmacies in the woman s inner city neighborhood told her they didn t carry the opioid. I finally had to call her primary pharmacy and tell them to make sure the patient received the morphine, Dr. Mattix said.