Study: Policies interfere with pain management

Good pain control is an essential component of medical care for people with serious illnesses, but state policies can stand in the way of pain relief, according to a study by the Pain and Policy Studies Group at Comprehensive Cancer Center.

The study is the first phase of a major pain and public policy research project funded by the Robert Wood Johnson Foundation, Princeton, NJ.

“Some states’ laws and regulations that govern the use of pain medications lack balance,” according to David Joranson, group director. “State policies aimed at preventing drug abuse often fail to recognize that these drugs are also necessary for medical purposes. Federal law addresses both points. The situation perpetuates misunderstandings about these drugs. Ironically, some new state laws that were meant to improve patients’ access to pain management may actually make them harder to get.”`

Although there are many treatments for pain, pain experts agree that opioid drugs (like morphine) are the most effective treatment for severe pain, which may accompany many illnesses, including cancer.

But Joranson says opioids are underused in pain management for a variety of reasons, including greatly exaggerated fears of addiction, lack of physician training, and physicians’ reluctance to prescribe them because they are afraid of being investigated for violating the law.

PPSG has been working with the state medical boards that license doctors to update their knowledge about state-of-the-art pain management and to revise their guidelines in this area. Now PPSG has expanded its scope to a review of state laws and regulations.

“Achieving Balance in State Pain Policy” presents the results of the PPSG analysis of 17 states’ policies that govern controlled substances, and medical and pharmacy practice.

The report provides a model for evaluating pain-related policy. It can be used by government agencies, legislatures, patient and professional groups, and others increased in improving pain-related policy. The 242-page report contains a section for each of the states studied so far, and identifies specific policies that may enhance or impede pain management. The report also presents alternative policy language that can be considered in place of problematic provisions.

Joranson said that “the criteria used in the evaluation were derived from a central principle, ‘balance,’ a principle of law and medicine that should appear in all policies aimed at preventing abuse of controlled substances. This principle is derived from authoritative international and national sources and it tells us that drug-related policies should not only prevent non-medical use of drugs, but also must not interfere in their medical use.”

The report also provides information about trends in state pain policies and the status of state prescription monitoring programs, as well as suggestions for what state legislatures can do to encourage better pain management for their residents.

To get the report, contact the Pain and Policy Studies Group, 1900 University Avenue, Madison, WI 53705; phone (608) 263-7662; fax (608) 263-0259; e-mail ppsg@macc.wisc.edu.