Government regulatory influences on opioid prescribing and their impact on the treatment of pain of nonmalignant origin

Abstract

Interpretation of regulations establishing standards for prescribing opioids by government regulatory boards and drug-enforcement agencies is more restrictive for treatment of nonmalignant pain than for malignant pain. Authority to regulate opioids is provided by health practice acts enacted by state governments, and controlled substances acts, enacted by both state and federal governments. The methods used by boards/agencies to determine standards of practice for opioid use result in interpreting the language in these regulations based on myths, prejudices, and misinformation about opioids, and the unexamined belief that mere exposure of patients to these drugs causes psychological dependence (addiction) on them to all patients in all instances. Interpretation is also strongly influenced by a failure of regulatory and enforcement bodies to recognize their coequal obligation of making opioids readily available to those who need them for legitimate medical purposes, while simultaneously policing their diversion to illegitimate uses. Emphasis on the police function of preventing diversion is paramount. Disciplining practitioners using standards based on myths, prejudices, etc., reinforces physicians' fears of prescribing opioids for nonmalignant pain. Patients with nonmalignant pain who are not relieved tf opioids are not provided will continue to suffer until regulatory boards/drug enforcement agencies define the standards of practice for opioid use for nonmalignant pain in dear and unequivocal terms. It is unlikely these standards will be developed until there is a consensus among pain specialists about opioid use for nonmalignant pain because boards/agencies have no consistent, reliable source of expert information: Pain specialists should initiate efforts to develop this consensus.