A Guide to State Opioid Prescribing Policies

Pain Policy and Regulation: Wisconsin

Medical Examining Board of the State of Wisconsin Position Statement on Pain Management

• The mission of The Medical Examining Board is to promote and protect the health and welfare of the citizens of the State of Wisconsin by fostering the provision of safe and competent medical care. The Board recognizes that such care involves the provision of appropriate and effective management of pain.
• The undertreatment of pain continues to be a significant public health problem in the United States. Inadequate pain control may result from physicians' lack of knowledge about pain assessment and management and/or their misunderstanding of the safety and efficacy of opioid analgesics, drugs that are essential for the management of moderate to severe pain. Physicians may also fear investigation or sanction by federal, state, and local agencies, which may lead to inappropriate treatment of pain.
• The Board encourages physicians to view effective pain assessment and management as part of quality medical care for all patients with pain, whether it is acute or chronic. It is especially important for patients who are experiencing pain at the end of life. All physicians should be knowledgeable about effective methods of pain assessment and treatment as well as the statutory requirements for prescribing controlled substances. The medical management of pain should be guided by current knowledge and acceptable medical practice, which includes the use of both pharmacologic and nonpharmacologic modalities. Pain should be assessed and treated promptly and appropriately, with clear documentation.
• The Board recognizes that opioid analgesics are subject to abuse by individuals who seek them for mood-altering and other psychological effects rather than for legitimate medical purposes. Physicians who use these drugs in the course of treatment should be diligent and incorporate established safeguards into their practices to minimize the potential for diversion and abuse.
• The Board further recognizes that tolerance and physical dependence are normal consequences of the sustained use of opioid analgesics and are not synonymous with psychological dependence (addiction). Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include: impaired control over drug use, craving, compulsive use, and continued use despite harm. Persons with a history of drug abuse have the right to appropriate pain management, even if opioids must be used. Such persons may require specialized care. Tolerance may occur, but it is not an inevitable consequence of chronic opioid therapy. Physical dependence is a normal and predictable state of adaptation to a drug, and by itself, physical dependence does not equate with addiction.
• Physicians should not fear disciplinary action from the Board for administering controlled substances, including opioid analgesics, for a legitimate medical purpose in the usual course of professional practice. The Board will initially consider the use of controlled substances for the treatment of pain to be for a legitimate medical purpose based on accepted scientific knowledge of the treatment of pain, clinical presentation of the patient, and sound clinical judgment. Proper written documentation and the patient's medical condition and clinical response to treatment provide strong foundations for verifying optimal patient care, if review of the patient record is necessitated at some future time.
• The Medical Examining Board of the State of Wisconsin is adopting and disseminating this position statement to support and encourage safe, competent, and high-quality medical care for persons with pain. By so doing, the Board clearly communicates to physicians that it:
  1. Encourages safe and effective pain management practices;
  2. Recognizes that pain management, which may involve the use of opioid analgesics, is a critical part of medical practice; and
  3. Will not sanction physicians solely for providing opioid analgesics provided the physician administers the medication in a safe and effective manner in compliance with state and federal law.
• Position statement developed in collaboration with the Wisconsin Pain Initiative (http://aspi.wisc.edu/wpi/).

Wisconsin Pharmacy Examining Board Position Statement on Pain Management

• The Wisconsin Pharmacy Examining Board has been approached by June L. Dahl, PhD, Director of the Wisconsin Pain Initiative, and Matt Bromley, Communications and Policy Director for the American Alliance of Cancer Pain Initiatives, to expand its position statement "Pain & Policy Studies Group on Wisconsin Pharmacists and Schedule II Medications," as published in the Board's Wisconsin Regulatory Digest, volume 13, number 2, October 2001. The article is available at: http://drl.wi.gov/boards/phm/digest/20011000.pdf
• A survey of Wisconsin pharmacists' knowledge and attitudes about dispensing opioid analgesics for chronic cancer and noncancer pain was published in the March/April 2001 issue of the Journal of the American Pharmaceutical Association. The article is available at: http://www.medsch.wisc.edu/painpolicy/publicat/01japhak/01japhak.htm. The study found that not all pharmacists knew what constituted legitimate dispensing practices for controlled substances under federal or state policy in emergencies or for patients with terminal illness. In addition, many pharmacists were unaware of the distinction between addiction, physical dependence, and tolerance. The Board encourages pharmacists to re-educate themselves with current literature on pain management. Appropriate pain control can improve or at least maintain a patient's quality of life. It is the pharmacist's duty to provide medications along with proper counseling to ensure pain control. The Pharmacy Examining Board considers refusal to fill a schedule II prescription based on speculation or ignorance unacceptable.
• Specifically, this expanded Position Board Statement clearly articulates to pharmacists that the Board:
  1. Encourages pain management;
  2. Recognizes that pain management, and the use of opioids for pain management, are a part of medical/pharmacy practice; and,
  3. Recognizes confusion exists around the terms addiction, physical dependence, and tolerance.
• While developing this statement, the Board surveyed multiple other states' position statements for completeness and consistency. The Board acknowledges use of the position statements of the Iowa and Texas Boards of Pharmacy.
• As with all professional and practice questions, the Board encourages Pharmacist contact if clarification is required. Written correspondence is preferred, either via the Department of Regulation and Licensing URLs or through the US Postal Service.

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Author Information

David Brushwood RPh, JD, Professor, University of Florida College of Pharmacy, Gainesville

Disclosure: David B. Brushwood, RPh, JD, has disclosed no relevant financial relationships.