Unbalanced and misleading media coverage on the abuse of opioid analgesics not only perpetuates misconceptions about pain management; it also compromises the access to adequate pain relief sought by over 75 million Americans living with pain.
In the past several years, there has been growing recognition by health
care providers, government regulators, and the public that the
under-treatment of pain is a major societal problem.
Pain of all types is under-treated in our society. The pediatric and geriatric populations are especially at risk for under-treatment. Physicians’ fears of using opioid therapy, and the fears of other health professionals, contribute to the barriers to effective pain management.
In 2001, in an unprecedented collaboration, the US Drug Enforcement Administration (DEA) joined 21 Health Groups, including the American Medical Association, in calling for balanced policy governing prescription pain medications. In August 2004, the DEA issued a document entitled Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel, however, the agency withdrew its support for the document less than 2 months later saying that it "contained misstatements" and "was not approved as an official statement of the agency."
The AMA supports the position that (1) physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain should not be subject to the burdens of excessive regulatory scrutiny, inappropriate disciplinary action, or criminal prosecution. It is the policy of the AMA that state medical societies and boards of medicine develop or adopt mutually acceptable guidelines protecting physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain before seeking the implementation of legislation to provide that protection; (2) education of medical students and physicians to recognize addictive disorders in patients, minimize diversion of opioid preparations, and appropriately treat or refer patients with such disorders; and (3) the prevention and treatment of pain disorders through aggressive and appropriate means, including the continued education of physicians in the use of opioid preparations.
The Federation of State Medical Boards’ Model Guidelines for the Use of Controlled Substances for the Treatment of Pain, encourage adequate pain management and address physician concerns about disciplinary actions by medical boards. These guidelines were recently updated to ensure currency and adequate attention to the treatment of pain. Policies and guidelines of the American Pain Society, the American Academy of Pain Medicine, the American Geriatric Society, and the American Society for Addiction Medicine also encourage the appropriate use of opioid analgesics for pain management.
At its annual policy-making meeting in the summer of 2003, the AMA House of Delegates adopted policy recommendations stating their opposition to the harassment of physicians by DEA agents in response to the appropriate prescribing of controlled substances for pain management, as well as to the inappropriate use of 21 Code of Federal Regulations Section 1306.04 or any other rationale that would involve placement of licensure restrictions on physicians who use opioid analgesics and other pain-reducing medications appropriately to treat patients with pain. The AMA requests that state medical and specialty societies submit examples of physicians who allegedly have been harassed by DEA agents for appropriate prescribing of controlled substances for pain management to the AMA's Office of General Counsel.
The AMA is committed to the goal of protecting the legitimate use of prescription drugs for patients in pain. And education is the best medicine. To this end, the AMA has created a national Pain Management CME program for physicians to address many of these issues. The review board for this activity consists of expert reviewers from 16 medical specialty societies and other professional health care organizations. The CME program was funded through an unrestricted educational grant from Purdue Pharma, L.P.
In addition, the American Academy of Pain Medicine recently announced a new initiative, named TOP MED (Topics in Medicine), a comprehensive "virtual textbook" on treating patients of all ages suffering from different types of pain. The web-based, self-directed textbook will be made available free of charge to medical students across the country in the fall of 2004.
Preventing drug abuse remains an important societal goal—it should not hinder patient’s ability to receive the care they need and deserve or discourage physicians from prescribing pain medications when medically appropriate.