In this issue of the journal, Dr. C. Stratton Hill discusses the negative influences of regulatory boards and state laws on the use of opioids to manage pain. Concern about regulatory barriers to appropriate prescribing has recently been discussed by others as well. A review of controlled substances laws and regulations confirms that federal law specifically recognizes the use of opioids in intractable pain. But state laws, while implicitly allowing the practice, do not give it explicit recognition. Unfortunately, some states' legal definitions confuse addiction with physical dependence and restrict the number of dosage units that may be prescribed.
Some states require special government-issue prescription forms.
A survey of state medical licensing and disciplinary board members showed that only three-fourths were confident that prescribing opioids for an extended period for cancer pain was both legal and acceptable medical practice. If a history of drug abuse was also present, the perception that the practice was illegal was even greater. Most board members recognized the extent to which people with cancer are likely to suffer pain, but underestimated the degree to which cancer patients are under medicated, and overestimated the incidence of addiction. Overall, board members were interested in pain management issues. A recent survey of Wisconsin physicians found that although concerns about regulatory scrutiny ranked low compared to concerns about addiction, more than half of the respondents indicated that due to concerns about regulatory scrutiny, they either reduce drug dose or prescription quantity, reduce the number of refills, or choose a less potent drug in a lower schedule because of concerns about regulatory scrutiny.