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(note: The first 3 paragraphs are reprinted with the permission of the
American Society of Law, Medicine & Ethics)D.E. Joranson and A.M. Gilson, "Improving Pain Management Through Policy Making and Education for Medical
Regulators" Journal of Law, Medicine & Ethics , 24
(1996): 344-347
Improving Pain Management
Through Policy Making and
Education for Medical
Regulators
David E. Joranson, Aaron M. Gilson
Physician concern about regulatory scrutiny as a barrier to appropriate prescribing for pain management has been
identified and studied.(1) A 1991 Pain Research Group survey demonstrated a need to provide updated information
about opioids and pain management to state medical board members.(2) Indeed, a national survey even showed a need
to provide more education about pain management to oncology physicians.(3) Two approaches for responding to these
concerns have been undertaken in several states by the state medical boards and the pain management community:
(1) the development and adoption of administrative policies designed to bring disciplinary standards in line with
clinical practice; and (2) the creation of education programs for state medical board members and staffs. Each can
have a substantial impact on removing real and perceived regulatory barriers to effective pain relief.
Guidelines
State medical boards have a duty to protect the public from improper prescribing, but they also have an interest in
promoting public health. Although the use of opioid analgesics to manage chronic noncancer pain is being reassessed
clinically and scientifically,(4) some state medical boards have already recognized and responded to the need to clarify
their policies regarding prescribing for pain.(5) Policy making and clarification by the boards themselves, especially
when produced through collaboration with the pain management community, can significantly contribute to
harmonizing clinical practice and regulatory policy.
In some instances, boards have adopted guidelines on the use of controlled substances in pain management to
address inappropriate uses of opioids and unprofessional prescriptive practices. More recently, however, some boards
have begun using guidelines to address physicians' fear of board investigation or discipline for prescribing opioids
for chronic noncancer pain. Indeed, respondents to the 1991 national survey of U.S. medical board members
supported a call for medical boards to clarify their policies. Most members who were surveyed said, at that time, they
would discourage a physician from prescribing opioids for a patient with chronic noncancer pain, and approximately
one-third said they would investigate the practice as a potential violation of law.(6)
