PPSG U.S. News Alerts
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The Pain and Policy Studies Group
(PPSG) would like to call your attention to two recent publications that may
be of interest in relation to state pain policies. For further information,
please contact Jody Jorenby, Communications Coordinator, jpjorenby@facstaff.wisc.edu,
608-263-5438.
1. Decade of progress. The February 2002 issue of the Journal of Pain and Symptom
Management describes a ten-year program of research, education, and policy development
to improve state medical board policies on the use of opioids for the treatment
of chronic cancer and non-cancer pain. The current article reviews each step
in the program and describes the extent to which states have adopted “Model
Guidelines for the Use of Controlled Substances for the Treatment of Pain.”
[http://www.fsmb.org] A number of recommendations
are made. The authors include David E. Joranson and Aaron M. Gilson of the PPSG,
and Dr. June L. Dahl and Dr. J. David Haddox who served as faculty for the PPSG
workshops for medical board members from 1996 to 1998. Last year the PPSG reported
two studies [http://www.medsch.wisc.edu/painpolicy/publicat/01jpsm/index.htm]
that showed positive and lasting changes in state medical board members’
understanding of the use of opioids for chronic pain. The work was supported
by the Robert Wood Johnson Foundation and Advocates for Children’s Pain
Relief. Go to the article at: http://www.medsch.wisc.edu/painpolicy/publicat/02jpsm1/index.htm.
2. Annual Review of state pain policies
for 2001. Also in February, the PPSG published a monograph (the Annual Review)
that presents and evaluates new state pain policies adopted in 2001. In 2001,
six policies were adopted in five states: Kentucky, Missouri, Tennessee, Texas,
and West Virginia. These included three medical board guidelines and one pharmacy
board policy statement modeled after the “Model Guidelines for the Use
of Controlled Substances for the Treatment of Pain”, one joint policy
statement about end-of-life care emphasizing the need for interdisciplinary
collaboration, and one Intractable Pain Treatment Act (IPTA). The Annual Review
concludes that the Model Guidelines continue to serve as a good foundation for
balanced policy from state licensing boards, while IPTAs lack balance. The authors
are the staff members of the PPSG. The work was supported by the Robert Wood
Johnson Foundation. Go to the article at: http://www.medsch.wisc.edu/painpolicy/publicat/01annrev/contents.htm.
The Pain and Policy Studies Group (PPSG) would like to announce a recent publication about prescription monitoring programs. It may be of interest to health professionals, law enforcement, regulatory personnel and pain patients. For further information, please contact Jody Jorenby, Communications Coordinator, jpjorenby@facstaff.wisc.edu, 608-263-5438.
The March 2002 issue of the Journal of Pain and Symptom Management describes a collaborative project initiated by the Pain & Policy Studies Group that brought together regulatory and pain management representatives to exchange information and views about PMPs. The objective of this article is to provide accurate information about PMPs, address the balance between preventing drug diversion and providing pain management, and encourage continued dialog and cooperation between regulatory and pain management groups. The authors include staff members of the PPSG, representatives of state PMPs, as well as the DEA. This project was supported by the Robert Wood Johnson Foundation. Go to the article at: http://www.medsch.wisc.edu/painpolicy/publicat/02jpsm2/index.htm.
David E. Joranson, director of the Pain & Policy Studies Group, is the recipient of the second Marie Nyswander Humanitarian Award for his “extraordinary efforts to enhance the compassionate care of addiction and pain.” The award was presented to Mr. Joranson at the International Conference on Pain & Chemical Dependency in New York City on June 7, 2002.
The late Dr. Marie Nyswander and her husband Dr. Vincent Dole have been pioneers in the treatment of opiate addiction through methadone treatment. Their distinctive mission and life work, dedicated to understanding opiate addiction and ministering compassionate care to opiate addicted persons, has helped enrich and indeed save the lives of thousands.
Dear Colleagues:
Of what value is good policy if no one knows about it? The Pain & Policy Studies Group (PPSG) wishes to announce the addition of a recent article to our web site, entitled “North Carolina, pain management and end-of-life care: Communicating the policy.” It describes the efforts of the North Carolina Medical Board (NCMB) to develop and communicate new pain-related policies to licensees and the public. The NCMB is an example of how a state medical board can be proactive in the development and communication of policies to improve pain management and end-of-life care. View the article at http://www.medsch.wisc.edu/painpolicy/publicat/02fsmb/index.htm.
SOON TO BE AVAILABLE ON-LINE:
A special issue of the Clinical Journal of Pain included a PPSG article on the
status of federal and state policies governing the medical use of opioid analgesics
for pain management with patients with an addictive disease. The article focuses
on specific policy barriers and recent policy initiatives that may improve the
use of controlled substances to treat pain for all patients, including those
with addiction. The citation can be found at http://www.medsch.wisc.edu/painpolicy/biblio.htm
under United States Publications and the text of the article will be available
on our web site in a few short weeks.
Staff members of the PPSG take this opportunity to wish you happy holidays and peace for the New Year.
With warm wishes,
David Joranson
Sophie Colleau
Aaron Gilson
Karen Ryan
Janet Kline
Martha Maurer
Jody Jorenby
Linda Gorman
New Guidelines for Assessment & Management of Chronic Pain
PPSG would like to call your attention to new Guidelines for the Assessment and Management of Chronic Pain. They were produced by a panel of experts for the Wisconsin Medical Society, chaired by Sridhar Vasudevan, MD, and published recently in the Wisconsin Medical Journal, Volume 103, No. 3, 2004. They are clear, balanced and contain recommended reading, a pre-visit health questionnaire, equianalgesic dosing table, a patient-physician agreement and guidelines for the use of controlled substances, and a summary of relevant Wisconsin controlled substances laws and regulations.
According to Dr. Vasudevan, "The new Guidelines are designed to support Wisconsin's primary care physicians as well as non-physicians to provide quality management of patients with persistent pain. The Task Force recognized and addressed the fact that many physicians find pain difficult to diagnose and treat and may be reluctant to use the full spectrum of available analgesics due to concern about regulatory oversight or undue fears that patients will develop addiction. The new guidelines emphasize an open approach to the patient, consideration of multiple etiologies, consultation, development of a treatment plan, careful documentation, communication among treating professionals, patient responsibilities and self-management skills."
The guidelines can be accessed at http://www.wisconsinmedicalsociety.org/uploads/wmj/pain_manageguides.pdf, or by calling the Wisconsin Medical Society WMS at 800-362-9080.
A balanced approach to prescription pain medications
On August 11, 2004 the U.S. Drug Enforcement Administration released an FAQ in cooperation with pain and addiction experts, the Last Acts Partnership and the University of Wisconsin Pain & Policy Studies Group. The FAQ stresses the need for education of clinicians, law enforcement and regulators about "balance", so that efforts to treat pain avoid contributing to abuse and efforts to stop diversion do not interfere with pain management.
How should the messages in the FAQ be communicated and implemented? How could you or your organization help to ensure that the FAQ reaches clinical and enforcement/regulatory audiences in your country or state, as well as the public? Is there a need in your area for better balance? Do clinicians fear investigation? Do clinicians know how to manage pain and also how to minimize abuse? Can patients obtain their medications when they are medically necessary? Are the specific sources of diversion of pain medication understood and being addressed without interrupting legitimate medical practice and patient care? How could a balanced approach be further incorporated into clinical practice, law enforcement and regulation? Are there opportunities to encourage a more balanced medical and regulatory environment for pain management, through websites, newsletters, articles, conferences, policy development, work with the media? How could "balance" be explored with national and state medical, pharmacy and nursing organizations, and with regulatory and enforcement agencies? Is this an appropriate topic for discussion by the boards of directors, steering committees and advisory panels of pain, palliative care, and end-of-life organizations?
You may contact the DEA to obtain hard copies of the FAQ by calling (202) 307-7297. (HARD COPIES WILL NOT BE AVAILABLE UNTIL OCTOBER.) The FAQ is available on the PPSG website at www.medsch.wisc.edu/painpolicy; you are welcome to link to it. Please contact Jody Garthwaite at jgarthwaite@wisc.edu for assistance. On the PPSG website you will also find resources that further explain the balanced approach to pain, addiction and diversion, including studies about knowledge and attitudes of pharmacists and medical regulators, evaluations of federal and state policies, and a full text database of state pain policies.
In the next two weeks, PPSG will send you an email about a new article that updates trends in the medical use and abuse of opioid pain medications and discusses the sources of diversion and the need for balance in addressing abuse and diversion of pain medications.
In our August 18 announcement regarding the DEA/Last Acts Partnership/PPSG release of the FAQ, we mentioned that the Pain & Policy Studies Group would inform you of the publication of a new article. PPSG has used recent data to update trends in the medical use and abuse of opioid analgesics, in which there is also a discussion of the implications for controlling diversion of pain medications. The article appears in the August 2004 issue of the Journal of Pain and Symptom Management, available at http://www.medsch.wisc.edu/painpolicy/publicat/04jpsm/index.htm. This article updates earlier research published in JAMA in 2000, and uses federal data on retail distribution of controlled substances and emergency department mentions of drug abuse from 1997 through 2002.
The study examines trends in the medical use and abuse of fentanyl, hydromorphone, meperidine, morphine, and oxycodone, and compares abuse of opioids to other drug classes. Marked increases were noted in both the medical use and abuse of these pain medications; opioids accounted for 9.85% of all drug abuse in 2002, up from 5.75% in 1997. Although increased medical use of opioids is considered a general indicator of progress in providing pain relief, growing opioid abuse and diversion is an important public health concern and should be addressed in a balanced manner, without interfering in legitimate medical practice or patient care. The authors provide a discussion about the principle of balance, and a rationale for understanding, tracking, and addressing sources of abuse and diversion.
The article was reviewed by numerous experts in pain and addiction medicine, and law. Funding was provided by grants from the Robert Wood Johnson Foundation and The Project on Death in America.
On August 11, 2004, the U.S. Drug Enforcement Administration (DEA), the Last Acts Partnership, and the University of Wisconsin Pain & Policy Studies Group (PPSG) released "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals, and Law Enforcement Personnel." The DEA has recently removed this document from their website and consequently has asked the PPSG to remove it from our site as well. Check the DEA's website for a statement explaining the removal of this document. We deeply regret any inconvenience this may cause.
Any questions should be directed to the DEA.
On October 6, the University of Wisconsin Pain & Policy Studies Group (PPSG) announced a communication we received from the Drug Enforcement Administration (DEA), in which we were informed by letter, dated October 4, 2004, that the DEA had rescinded it’s endorsement of the recently publicized document, Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel (FAQ). The DEA notified us that they had removed the FAQ from their website, citing that the document contained misstatements, and asked the PPSG to do likewise. The PPSG, along with several other organizations housing the FAQ, removed the document from their websites.
In response to this issue, members of the principal working group involved in the FAQ (Steven Passik, PhD; Russell Portenoy, MD; and David Joranson, MSSW) have written a letter to the DEA Administrator Karen Tandy. The letter asks that the DEA: (1) publicly reaffirm its commitment to achieving balance, (2) explain the misstatements in the FAQ so they can be addressed, (3) advise as to whether the agency plans to revive and disseminate the FAQ or a similar educational effort, and (4) tell how the agency proposes to restart a dialogue with the clinical community that is dedicated to pain management.
A copy of both letters can be seen on the PPSG website at the following URL: http://www.medsch.wisc.edu/painpolicy/DEA/index.htm
Missouri, Minnesota, and Virginia Adopt New Pain Policies
Following the adoption of the Federation of State Medical Board’s “Model Policy for the Use of Controlled Substances for the Treatment of Pain,” (“Model Policy”) in May, 2004, state health professional regulatory boards in Missouri, Minnesota and Virginia adopted new pain policies.
The Missouri State Board of Healing Arts recently adopted a modified version of the Model Policy. To read the full text of the policy: http://pr.mo.gov/boards/healingarts/CSGUIDE.pdf
The Virginia Board of Medicine adopted the Model Policy in its entirety in June of 2004. To read the full text of the policy: http://www.medsch.wisc.edu/painpolicy/domestic/vamodpol.htm
In addition, the Minnesota boards of Medical Practice, Nursing and Pharmacy issued a “Joint Statement on Pain Management” in September of 2004. To read the full text of the policy: http://www.state.mn.us/cgi-bin/portal/mn/jsp/content.do?subchannel=null&programid=536904249&sc3=null&sc2=null&id=-536886235&agency=BMP
As a reminder, the Pain & Policy Studies Group at the University of Wisconsin provides public access to the full text of all state pain policies at http://www.medsch.wisc.edu/painpolicy/matrix.htm. Comments and questions are always welcome.
The Drug Enforcement Administration (DEA) has issued an Interim Policy Statement (IPS) in the Federal Register (Vol. 69, No. 220) regarding the document "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel." The IPS describes the "misstatements" identified in the document by the DEA and explains how the DEA plans to address them and the issue of dispensing controlled substances for the treatment of pain in a future Federal Register.
The IPS can be found
at:
http://a257.g.akamaitech.net/7/257/2422/06jun20041800/edocket.access.gpo.gov/2004/pdf/04-25469.pdf
(URL no longer available)
The PPSG is evaluating the IPS and preparing a response.
In response to the DEA’s Interim Policy Statement (IPS) issued in the November 16, 2004 Federal Register, the University of Wisconsin Pain & Policy Studies Group has submitted a written response. A PDF version of the letter, as well as the sequence of events prior to this response, is available at http://www.medsch.wisc.edu/painpolicy/DEA/index.htm.
In response to the DEA's Solicitation of Comments dated January 18, 2005 (Docket No. DEA-261), the University of Wisconsin Pain & Policy Studies Group has submitted a written response. Individuals and organizations are welcome to refer to it. A PDF version of the letter is at http://www.medsch.wisc.edu/painpolicy/DEA/DEA_261_response.pdf.
Please note that to be eligible for official consideration, all comments, including those which may have been sent earlier, must reference the Docket Number, and be sent to DEA according to the instructions in the January 18 solicitation, which is at http://www.medsch.wisc.edu/painpolicy/DEA/FR_pain_solicit.pdf.
Update on state prescription monitoring programs. According to a recent review
by the Pain & Policy Studies Group (PPSG), 21 states have PMPs or legislation
that allows implementation of a PMP. There has been a steady increase in the
number of states with PMPs that rely on electronic transmission of prescription
data and that monitor most or all classes of controlled substances. In addition,
several more states are considering PMP legislation. The PPSG encourages publication
of studies that show that PMPs reduce drug abuse and diversion without interfering
in medical practice.
A trend graph and listing of states
can be found at:
http://www.medsch.wisc.edu/painpolicy/domestic/diversion.htm
The Pain and Policy Studies Group (PPSG) would like to call your attention to a recent article titled “Progress to Achieve Balanced State Policies Relevant to Pain Management and Palliative Care, 2000-2003”, published in the Journal of Pain & Palliative Care Pharmacotherapy. This article summarizes and discusses the evaluation and grading of state pain policies and reports on positive policy changes at the state level. A PDF version of the article can be accessed on the PPSG website: http://www.medsch.wisc.edu/painpolicy/publicat/05jppcp/05jppcp.pdf
The Pain and Policy Studies Group (PPSG) would like to call your attention to a recent article titled "State policy affecting pain management: Recent improvements and the positive impact of regulatory health policies," published in the journal Health Policy.
This article describes statistical analyses of a criteria-based evaluation of state drug control and professional practice policies that impact using controlled substances for pain management. The study compared content of: (1) policies active in 2000 with those in 2003, (2) statutes, regulations, and board guidelines and policy statements, (3) pain management policies to professional practice policies, and (4) pain management policies adopted by health care regulatory boards to those by state legislatures. Results showed that current policies contained more language that encouraged appropriate pain relief while also avoiding language restricting professional decision-making and patient treatment. Regulatory board guidelines and policy statements were more likely than statutes and regulations to promote pain management and have no restrictive language, and were less restrictive than policies that govern general professional practice. Recent policy improvement seems to result largely from regulatory board activity. The authors discuss the need to continue striving to attain balanced policy as a way to address the current public health problem of under-treated pain.
A PDF version of the article can be accessed on the PPSG website: http://www.medsch.wisc.edu/painpolicy/publicat/05hlthpol/05hlthpol.pdf
In July 2005, the PPSG conducted a search for state policies that either require or encourage physicians to take continuing medical education (CME) in pain management or palliative care. Ten states have such policies; five require CME in pain management or palliative care, while 5 encourage such CME. A few states also require or encourage medical school curriculum that includes pain management or palliative care. This review focused on policies related to physicians. Please let us know if you are aware of similar policies in your state or other states. The verbatim policy language and references for these policies can be found on the PPSG website at: http://www.medsch.wisc.edu/painpolicy/domestic/cme.htm
CONTACT: David E. Joranson 608-263-7662
or Linda Dietrich 608-263-6585
Pharmacy theft is an overlooked source
of abused pain medications
MADISON – A research letter published by the Journal of Pain and Symptom
Management reports that every year, thousands of armed robberies and thefts
from pharmacies, manufacturers and distributors result in millions of dosages
of opioid pain medications being diverted into the illicit market. The medications
are trafficked by drug dealers and then abused, often in combination with alcohol
and other drugs, leading to overdose and death.
“Drug Crime is a Source of Abused Pain Medications in the United States”
was written by David E. Joranson, MSSW, and Aaron M. Gilson, PhD, of the Pain
& Policy Studies Group at the University of Wisconsin Comprehensive Cancer
Center. The letter describes data received from the US Drug Enforcement Administration
(DEA) under a Freedom of Information Act request. The request was for theft
reports of prescription controlled substances that had been submitted to the
DEA by DEA registrants on federal Form 106. The information provided contained
analyzable data for only 22 Eastern states representing approximately one-half
the US population.
In the four-year period from 2000 to 2003, nearly 28 million dosage units of
all prescription controlled substances were diverted in 12,894 separate incidents
primarily involving pharmacies, and averaging more than 3,000 incidents per
year. In 2003, approximately 5.8 million dosages of opioid pain medications
were diverted, including hydrocodone, oxycodone, morphine, methadone, meperidine,
hydromorphone and fentanyl.
Diversion of this type occurs at places in the drug supply chain above the level
of prescribing, dispensing and patient use, and involves individual and organized
criminal activity by persons who are not licensed or registered to handle controlled
substances, and therefore would not be detected by programs that monitor prescribing.
The taking of controlled substances by force from DEA registrants became a federal
felony in 1984; more information is needed about how law enforcement is addressing
drug crimes against DEA registrants as a part of the national coordinated response
to prescription drug diversion. Addressing pharmacy theft could become a model
for achieving hoped-for “balanced” responses to diversion, because
these sources of diversion can be identified and addressed with little if any
risk of interfering in legitimate medical practice and patient care.
Future studies should examine trends and whether pharmacy thefts occur in particular
states and metropolitan or rural areas, evaluate the causes and methods of preventing
pharmacy crime, and determine what proportion of total diversion and abuse comes
from pharmacy theft or from other sources such as fraudulent prescriptions or
“pill mills.” Existing national drug abuse databases should collect
information on the source of abused drugs to a more evidence-based face on how
abused prescription pain relievers are obtained.
Joranson DE, Gilson AM. Drug crime is a source of abused pain
medications in the United States. J Pain Symptom Manage. 2005; 30(4):299-301.
(Available at http://www.medsch.wisc.edu/painpolicy/publicat/05jpsm/05jpsm.pdf.)
Dear Colleague,
As 2005 comes to a close, I would like to extend my best personal wishes to you for a healthy and successful New Year--and offer a few reflections on the year past and ahead.
In the US, 2005 was characterized by a mix of policy setbacks, new information about the source of abused pain medications, and an important transition. Following the US Drug Enforcement Administration’s (DEA) abrupt withdrawal from the interdisciplinary and balanced pain and regulatory education initiative known as the “FAQ”, DEA reversed its own long-standing policy on issuing Schedule II prescriptions and communicated a new aggressive tone about investigations. These actions precipitated a nationwide retrenchment in care of pain patients and law-abiding physicians’ concerns about being investigated have escalated. DEA requested comments on its actions; hundreds of comments were filed from healthcare professionals, associations, regulators and law enforcement officials all over the country; DEA’s response is due early in 2006. We hope that DEA’s statement will include a recommitment to a balanced approach to diversion control that specifically avoids interfering in medical practice and patient access to pain management, assurance to practitioners that DEA agents will use diversion indicators that cannot be confused with legitimate medical practice, clarification of the increasingly blurred lines between professional practice, unprofessional conduct and criminal conduct, reaffirmation that a series of original prescriptions for Schedule II medications is legal, endorsement of the Federation of State Medical Board Model Policy, and establishment of communication mechanisms that will allow, as years past, communication between DEA and practitioner, law enforcement, regulatory and patient groups. http://www.medsch.wisc.edu/painpolicy/DEA/index.htm
In 2005, the PPSG published preliminary
first-of-a-kind quantitative data about the amount of diversion of prescription
drugs including opioid analgesics. We obtained data from federally-required
reports which showed that in the last four years approximately 28 million dosages
of prescription controlled substances were unlawfully diverted from the US drug
supply chain into channels of illicit distribution and abuse. This tremendous
quantity was based on reports from only 22 states; in 2003 alone, 5.8 million
dosages of prescription opioid analgesics were diverted in this manner. Clearly,
the reported increase in abuse of “prescription opioids” does not
necessarily mean the opioids came from prescriptions. Twenty years ago, pharmacists
terrorized by armed robberies convinced Congress to make theft of controlled
substances from DEA-registered pharmacies a federal felony. Yet today, we know
that thousands of incidents of theft and robbery resulting in diversion continue
to occur every year, and we know nothing about the law enforcement response.
A fair and balanced federal approach to prescription drug abuse must take into
consideration all sources of diversion, including those criminal activities
for which DEA-registered pharmacists and physicians are not responsible.
http://www.medsch.wisc.edu/painpolicy/publicat/05jpsm/05jpsm.pdf
2005 was also a year for important transitions. Patricia Good retired from the DEA. She understood pain management and was a clear voice within DEA for balanced law enforcement approaches to drug diversion and cooperation with the pain and palliative care fields. She will be missed.
In contrast with the confusion in Washington, the States continued to make steady progress to achieve more balanced policies governing the medical use of controlled substances for pain. We have previously reported that a number of states have adopted, amended or repealed policies sufficient to improve their grade for balanced pain policy. http://www.medsch.wisc.edu/painpolicy/publicat/05hlthpol/05hlthpol.pdf In 2005, PPSG policy evaluation tools continue to be used by a number of organizations as road maps for achieving more balanced state pain policies.
On the international side, 2005 has been a year of important progress. The United Nations adopted new resolutions to address inadequate relief of pain in cancer and HIV/AIDS; all national governments have been asked to examine their laws and regulations for barriers to opioid availability; the World Health Organization and the International Narcotics Control Board have been requested to explore development of an assistance mechanism to support the work necessary to improve patient access to essential medicines, in particular the opioid analgesics. http://www.un.org/docs/ecosoc/documents.asp?id=863
A collaborative project with the Ministry of Health Palliative Care Commission in Romania is coming to fruition. The project began in 2002 with a WHO workshop to assist Eastern European countries to identify and remove regulatory barriers to patient access to opioid pain medications. In November 2005, the Romanian Parliament adopted a new and modern drug control law replacing the laws of the Ceausescu regime which for decades restricted physicians from prescribing more than a 3-day supply of opioids; 10-15 day supplies were possible for cancer patients but only if they were “incurable,” and not at all for patients with HIV/AIDS. Within six months the Ministry will adopt new regulations to implement the new law; the regulations have already been drafted by a team of Romanian experts during a visit to the PPSG. We are excited that 2006 may bring a new national drug policy that will strike a balance between control and availability, allow modern pain control practices in Romania and be an example for Eastern Europe and the Former Soviet Union. Look for a journal article soon.
2006 will mark the tenth anniversary for the PPSG. We look forward to announcing plans to expand our policy research and communications programs in the US and internationally, including improvements to the PPSG website at www.medsch.wisc.edu/painpolicy. We will continue to email you periodic updates and, as always, would look forward to comments you may have as we work toward our collective vision of relieving pain and suffering.
Best wishes for the New Year
David E. Joranson, Senior Scientist
Director
Pain and Policy Studies Group
University of Wisconsin Comprehensive Cancer Center
WHO Collaborating Center for Policy and Communications in Cancer Care
Cancer foundations support evaluation of US pain policies
The Pain & Policy Studies Group (PPSG) is pleased
to announce joint funding of its US pain policy evaluation program by the American
Cancer Society, the Susan G. Komen Breast
Cancer Foundation and the Lance Armstrong
Foundation. Each of these highly respected organizations have announced
that they will provide a three-year grant to enable the PPSG to evaluate federal
and state laws, regulations and agency guidelines that can impact patient access
to effective pain relief. PPSG will prepare state policy profiles for the next
three years, as well as report cards that grade states’ policies and compare
them to the 2000 and 2003 grades. Release of the 2006 reports is anticipated
in September, which is Pain Awareness Month.
2006 update on Prescription Monitoring Programs (PMPs)
According to a recent review performed by the Pain & Policy Studies Group (PPSG), 26 states (Alabama, California, Colorado, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Massachusetts, Michigan, Nevada, New Mexico, New York, North Carolina, Ohio, Oklahoma, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, and Wyoming) have adopted laws establishing Prescription Monitoring Programs (PMPs). The purpose of PMPs is to monitor the prescribing of certain controlled substances to detect illicit prescribing and dispensing and identify patients who are obtaining prescriptions from multiple sources. All 26 PMPs rely on electronic transmission of data from pharmacies, although New York and Texas still require practitioners to obtain and use state-issued, serialized prescription forms in addition to the electronic component. Evidence indicates a continuing increase in the number of states with PMPs or that are considering PMP legislation.
The PPSG encourages research to evaluate the impact of PMPs on both access
to medications for patients needing controlled substances for legitimate medical
purposes and the incidence of drug abuse and diversion. Through these efforts,
an accurate assessment of the success of PMPs in achieving a balanced approach
can be made.
A trend graph, a list of states with PMPs and other resources, including federal
government documents encouraging states to use Medicaid data to identify prescription
drug diversion, can be found at: http://www.painpolicy.wisc.edu/domestic/diversion.htm.
PPSG releases 2006 policy evaluation reports
The University of Wisconsin Pain & Policy Studies Group (PPSG),
as part of our ongoing pain and public policy research program, has released
today:
and
The new edition of the Evaluation Guide is the third in a series of evaluations
of federal and state pain policies. The Progress Report Card quantifies state
pain policies, and benchmarks progress to promote pain management and reduce
policy barriers by comparing 2006 state policy grades with those from 2000 and
2003. The 2006 editions were expanded to give a more complete picture of the
policy environment in each state, including professional education, healthcare
facility care standards, and osteopathic practice.
To view or download these reports, as well as a national press release and Frequently
Asked Questions, visit the PPSG website through our new URL at www.painpolicy.wisc.edu.
These reports are supported by grants from the American
Cancer Society and the Susan G. Komen Breast
Cancer Foundation, and through a cooperative agreement with the Lance
Armstrong Foundation.
Are increasing opioid analgesic deaths caused by pain management?
In a recent article in Pharmacopidemiology and Drug Safety1, researchers from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, report on the tragic increase in drug poisoning deaths involving opioid analgesics. The authors link the rising opioid mortality with increasing medical use of opioids analgesics for "more aggressive pain management" (p. 618)
In an adjoining commentary2, David Joranson and Aaron Gilson call attention to the risks of using correlations to make causal statements that implicate pain management; they review significant evidence of non-medical sources of diversion of opioid analgesics, including millions of doses of prescription opioid analgesics that have been stolen from pharmacies before being prescribed3. Recommendations are offered for a public health examination that can inform effective interventions.
1. Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology and Drug Safety 2006;15:618-627. (Accessed through http://www.painpolicy.wisc.edu/commentary.htm)
2. Joranson DE, Gilson AM. Wanted: A public health approach to prescription opioid abuse and diversion (Editorial). Pharmacoepidemiology and Drug Safety 2006;15:632-634. (Accessed through http://www.painpolicy.wisc.edu/commentary.htm)3. Joranson DE, Gilson AM. Drug crime is a source of abused pain medications in the United States [letter]. J Pain Symptom Manage 2005;30:299-301. (Available at http://www.painpolicy.wisc.edu/publicat/05jpsm/05jpsm.pdf)
Clarification needed on DEA proposal
The PPSG calls your attention to our commentary on the DEA's proposed regulation to allow a "prescription series," in which we pose several important questions about how the regulation will be interpreted by law enforcement and practitioners. The Commentary is accessible on the PPSG website at http://www.painpolicy.wisc.edu/DEA/Rx_series.pdf.
Comments are welcome.
Diversion of Prescription Opioids
In recent years, attention to the increasing and tragic consequences
of abuse of opioid analgesics has led some to suggest that the main source of
the problem is physicians' prescribing to pain patients, rekindling fears about
regulatory scrutiny and doubts about the use of these important medications.
Such assertions need to be examined in light of evidence that there are many
sources of diversion, including theft of large quantities from pharmacies before
they are prescribed. We need to assess the sources of the problem and address
them without interfering in legitimate medicine and pain care.
Before coming to the pain field in the mid 1980s, I had more than a decade of
experience in designing and administering a state diversion prevention and control
program, and I founded a national association of state controlled substances
authorities. Drawing on this as well as recent experience, I would like to contribute
a piece that I think is missing from the current national discussion about diversion
and abuse, i.e., what is diversion, how does it occur, what information is available
to study it, and what are key research and policy questions. If this is of interest,
I invite you to view the short 15 slide presentation titled "Diversion
of Prescription Opioids."
David E. Joranson
Distinguished Scientist, Director
PPSG releases 2007 policy evaluation reports
The University of Wisconsin Pain & Policy Studies Group (PPSG), as part of our ongoing pain and public policy research program, has released today:
The new edition of the Evaluation Guide is the fourth in a series of evaluations
of federal and state pain policies. The Progress Report Card quantifies state
pain policies, and benchmarks progress to promote pain management and reduce
policy barriers by comparing 2007 state policy grades with those from 2000,
2003, and 2006. These tools can be used by government and non-government organizations,
as well as policy-makers, healthcare professionals, and advocates to understand
the policies in their state that reinforce the right to pain management, or
that can hinder patient access to effective treatment.
To view or download these reports, as well as a national
press release, Frequently Asked
Questions, and a summary
of grade changes, visit the PPSG website at www.painpolicy.wisc.edu.
These reports are supported by grants from the American
Cancer Society and Susan
G. Komen for the Cure, and through a cooperative agreement with the Lance
Armstrong Foundation.
Leadership Transition at PPSG
The
University of Wisconsin Pain & Policy Studies Group (PPSG) is pleased to
inform you of recent transitions in leadership.
We would like to announce that Mr. David Joranson, MSSW, Director and Distinguished Scientist, has retired. Mr. Joranson is remaining with the PPSG in an advisory capacity and is working on special projects.
The work of the PPSG will continue under the capable leadership of Co-Directors: Aaron M. Gilson, Ph.D., Director of U.S. Policy Research, and Karen M. Ryan, MA, Director of International Policy Research. We encourage you to contact Dr. Gilson or Ms. Ryan if you have questions regarding U.S. and international matters, respectively.
Please update your records for the PPSG accordingly:
Dr. Aaron Gilson, Director of U.S. Policy Research
amgilson@wisc.edu
Ms. Karen Ryan, Director of International Policy Research
kmryan2@wisc.edu
Mr. David Joranson, Distinguished Scientist, Founder
joranson@wisc.edu
Pain & Policy Studies Group
Paul P. Carbone Comprehensive Cancer Center
University of Wisconsin School of Medicine and Public Health
World Health Organization Collaborating Center for Policy and Communications
in Cancer Care
406 Science Drive, Suite 202 Madison, Wisconsin 53711-1068
www.painpolicy.wisc.edu
We remain committed to our mission of pain policy reform and access to essential pain relief medicines, which are long-term problems requiring a sustained policy and systems response.
Policy Evaluation Resources for the Practitioner
An article, titled “Improving state pain policies: Recent progress and
continuing opportunities,” was published in CA: A Cancer Journal for Clinicians.
This article presents recent results from the PPSG’s national policy evaluation
project, and describes how practitioners can use each state’s findings
to inform and guide state-level efforts to improve policies affecting appropriate
pain management and patient care. The article is available at http://caonline.amcancersoc.org/cgi/reprint/57/6/341.
Evaluating DEA’s New Regulation Governing Prescription Series
As a follow-up to their commentary earlier this year, Aaron Gilson and David
Joranson have issued another editorial piece examining the DEA’s amendment
to the Code of Federal Regulations regarding practitioners’ issuing of
a “prescription series” for Schedule II controlled substances. The
authors evaluate the Final Rule, which will become effective on December 19,
2007, to determine whether the DEA has developed a balanced policy. For further
information, please visit http://www.painpolicy.wisc.edu/DEA/Rx_Series_Adoption.pdf.
Happy holidays and all the best for 2008!
PPSG announces release of 2008 policy evaluation reports
The University of Wisconsin Pain & Policy Studies Group (PPSG) is pleased
to announce today the availability of:
These resources are the latest in a series of reports and are part of the PPSG’s continuing pain and public policy research program.
The Evaluation Guide contains findings from a criteria-based evaluation of the content of federal and state policies governing the use of controlled substances for pain management, palliative care, and end-of-life care. The Progress Report Card quantifies the quality of state pain policies, creating a grade for each state, and tracks changes in policy over time by comparing a state’s grade for 2008 to those from previous years. Overall, recent state efforts to improve pain policy have resulted in notable progress to promote pain management, reduce practitioners’ concerns about regulatory scrutiny, and repeal and avoid policy barriers.
These two reports are important tools for government and non-government organizations, as well as policy-makers, healthcare professionals, and advocates, to understand the policies in their state that support effective pain management or that can hinder medical decision-making and patient access to appropriate treatment.
Visit the PPSG website at www.painpolicy.wisc.edu to view or download these reports, as well as a national press release, Frequently Asked Questions, and a summary of grade changes.
These reports are supported by grants from the American Cancer Society and Susan G. Komen for the Cure, and through a cooperative agreement with the Lance Armstrong Foundation.
| PPSG Home | About the PPSG | US Pain Policy | International | WHO Newsletter | Glossary | Bibliography | Links | Search | Feedback |