Frequently Asked Questions

Frequently Asked Questions

Question: What can state legislatures do to improve pain management?

Response: First, study the problem. Create a multidisciplinary task force, commission or committee with public hearings to study carefully the barriers to pain management for all types of pain patients in the state (cancer, chronic non-cancer, post-surgical, sickle cell, AIDS, etc.); review relevant state policies outlined below; make and implement recommendations in legislation (policy, budget), in leadership, public information, education, training, program development, etc.).

1. Drug, pharmacy, controlled substances policy

Does the state controlled substances act recognize the essential medical uses of controlled substances as in federal law and as recommended by the National Conference of Commssioners on Uniform State Laws?
Does state law or regulations unduly restrict prescribing of controlled substances, e.g., government-required prescription forms; exclusion of addicts even if they have pain; require second opinion, consultation or informed consent; legal terminology confusing addicts with pain patients/addict reporting, limit number of dosage units of controlled substances (e.g., opioids) that can be prescribed at one time, or limit unrealistically the perioid of validity of a prescription for a scheduled substance?
Does state policy allow physicians and pharmacists to take full advantage of the flexibility in federal controlled substances regulation regarding faxing and partial dispensing of controlled substances prescriptions?

2. Medical policy

Do the medical practice act or regulations contain any policies with regard to prescribing controlled substances which are unduly restrictive or confusing when applied to the prescribing of controlled substances for the treatment of pain? (i.e., no prescribing to addicts, even if they have pain?)
Does the medical board have a policy statement or guidelines which clarifies that the board recognizes that the use of controlled substances for the treatment of chronic pain is accepted medical practice and clarifies the principles which a physician can follow to confidently avoid the risk of discipline or arrest by any agency in the state?

3. Facility regulation (hospice, nursing home, home care, etc.)

What is the attitude of the state facility regulators: is pain a priority or is the priority only reducing the use of controlled drugs; do certification and inspection criteria include assessment and treatment of pain and training of patient care staff; is technical assistance on pain and symptom management available.

4. State health policy

Does the state cancer control program include a funded emphasis on pain management and palliative care for cancer patients in the state?
Is there a state cancer pain initiative and does it have adequate support?
Does the public have access to information about pain and symptom management including chronic non-cancer pain, and where to go for help?
Does the 800 number for cancer information also include information about pain management?
Do managed care organizations have adequate policies: pain assessment, treatment, reimbursement, appropriate access to specialists?
Does state Medicaid policy reimburse the controlled drugs used in pain and symptom management?
Does Workers Compensation adequately address the needs of people with chronic severe pain?

5. Drug enforcement policy

Do the agencies in the state which are involved in drug law enforcement and monitoring of controlled substances prescribing, dispensing and patient use have adequate safeguards against the inappropriate scrutiny of practitioners who prescribe and dispense legitimate controlled substances?