COMMENTARY

New Standard of Care for Prescribing Opioids

Carolyn Buppert, MSN, JD

Disclosures

April 16, 2015

In This Article

Pain Management Guidance

In the past several years, at least 15 organizations, including societies of pain specialists, state health departments, medical boards, and a professional society of neurologists, have released guidelines for managing chronic, non-cancer pain. This is a new phenomenon, because until recently, clinicians were given little guidance on how to approach chronic pain.

The Drug Enforcement Administration (DEA) leaves much to clinician judgment, while cautioning to always prescribe for a "legitimate medical purpose" and "in the usual course of professional practice."[1] At the same time, the DEA revokes prescribers' registrations for "failure to conform to minimal standards of care of similar practitioners."[2] And the Department of Justice has been very active in recent years in shutting down so-called "pill mills," where prescribers often prescribe opioids without documenting a sufficient physical examination.[3]

As a result, some prescribers who have the authority to prescribe controlled drugs for pain have been reticent to do so for fear of being accused of prescribing inappropriately. And there has been disagreement within practice groups when, for example, some providers liberally prescribe controlled drugs for pain, and other providers feel uncomfortable when called upon to refill those prescriptions when the more liberally prescribing providers are out of the office.

The development of guidelines should bring some comfort to prescribers, in that they can feel assured that if they follow the guidelines, they will not be accused of inappropriate prescribing. Furthermore, practices can adopt a set of guidelines and agree that all providers will follow them. Finally, providers will have something to back up their refusals to prescribe outside the guidelines when challenged by patients who want to dictate their own care.

A sample of available guidelines (although by no means exhaustive) is provided in The table.

Table. Sample Available Pain Management Guidelines

Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain (2013) Federation of State Medical Boards

American Pain Society/American Academy of Pain Medicine Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain (2009)

American Society of Interventional Pain Physicians Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain (2012)

Opioids for Chronic Noncancer Pain: American Academy of Neurology position paper (2014)

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Noncancer Pain (2011)

Veterans Affairs/Department of Defense Management of Opioid Therapy for Chronic Pain (2010)

Utah Clinical Guidelines on Prescribing Opioids (2008)

New Hampshire Opioid Prescribing Resource for Chronic Non-Terminal Pain (2012)

Washington State Agency Medical Directors Group Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain (2010)

Oklahoma Opioid Prescribing Guidelines (2014)

California Board of Medicine Guidelines for Prescribing Controlled Substances for Pain (2014)

North Carolina Medical Board Policy for the Use of Opiates for the Treatment of Pain (2014)

Colorado Pain Management Resources (2014)

Tennessee Chronic Pain Guidelines (2014)

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