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Improving State Medical Board Policies: Influence of a Model

Published online by Cambridge University Press:  01 January 2021

Aaron M. Gilson ,
David E. Joranson  and
Martha A. Maurer
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Extract

Despite advances in medical knowledge regarding pain management, pain continues to be significantly undertreated in the United States. There are many drug and nondrug treatments, but the use of controlled substances, particularly the opioid analgesics, is universally accepted for the treatment of pain from cancer. Although opioid analgesics are safe and effective in treating chronic pain, there is continued research and discussion about patient selection and long-term effects. A number of barriers in the health care and drug regulatory systems account for the gap between what is known about pain management and what is practiced. Among the barriers are physicians’ fears of being disciplined by state regulatory boards for inappropriate prescribing.

State medical boards are in a unique position not only to address physicians’ concerns about being investigated, but also to encourage pain management. Prior to 1989, a few state medical boards had policies relating to controlled substances or pain. Subsequently, state medical boards began adopting policies regarding the prescribing of opioids for the treatment of pain; many of these specifically addressed physicians’ fear of regulatory scrutiny.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 31 , Issue 1 , Spring 2003 , pp. 119 - 129
Copyright
Copyright © American Society of Law, Medicine and Ethics 2003

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References

Breitbart, W., Kaim, M., and Rosenfeld, B., “Clinicians' Perceptions of Barriers to Pain Management in AIDS,” Journal of Pain and Symptom Management, 18, no. 3 (1999): 203–12; Breitbart, W. et al., “Patient-Related Barriers to Pain Management in Ambulatory AIDS Patients,” Pain, 76 (1998): 9–16; Cleeland, C.S., “Barriers to the Management of Cancer Pain,” Oncology, suppl. (April 1987): 19–26; Drayer, R.A., Henderson, J., and Reidenberg, M., “Barriers to Better Pain Control in Hospitalized Patients,” Journal of Pain and Symptom Management, 17, no. 6 (1999): 434–40; Ferrell, B.A., “Pain Evaluation and Management in the Nursing Home,” Annals of Internal Medicine, 123, no. 9 (1995): 681–87; Hill, C.S. Jr., “The Barriers to Adequate Pain Management with Opioid Analgesics,” Seminars in Oncology, 20, no. 2, suppl. 1 (1993): 1–5; Joranson, D.E., “Are Health-Care Reimbursement Policies a Barrier to Acute and Cancer Pain Management?,” Journal of Pain and Symptom Management, 9, no. 4 (1994): 244–53, available at <http://www.medsch.wisc.edu/painpolicy/publicat/94jpsma.htm>; Joranson, D.E., “Regulatory Influence on Pain Management: Real or Imagined?,” Journal of Pharmaceutical Care in Pain and Symptom Control, 1, no. 1 (1993): 113–18, available at <http://www.medsch.wisc.edu/painpolicy/publicat/93jpcpsc.htm>; Larue, F. et al., “Oncologists and Primary Care Physicians' Attitudes Toward Pain Control and Morphine Prescribing in France,” Cancer, 76, no. 11 (1995): 2375–82; McCaffery, M., “Pain Control: Barriers to the Use of Available Information,” Cancer, 70, no. 5 (1992): 1438–49; Rich, B.A., “An Ethical Analysis of the Barriers to Effective Pain Management,” Cambridge Quarterly of Healthcare Ethics, 9 (2000): 54–70; Tolle, S.W. et al., “Family Reports of Barriers to Optimal Care of the Dying,” Nursing Research, 49, no. 6 (2000): 310–17.CrossRefGoogle Scholar
Cancer Pain Management Policy Review Group, American Cancer Society Position Statement on Regulatory Barriers to Quality Cancer Pain Management (Atlanta: American Cancer Society, 2001); Haddox, J.D. and Aronoff, G.M., “Commentary: The Potential for Unintended Consequences from Public Policy Shifts in the Treatment of Pain,” Journal of Law, Medicine & Ethics, 26, no. 4 (1998): 350–52; Hill, C.S. Jr., “The Negative Effect of Regulatory Agencies on Adequate Pain Control,” Primary Care in Cancer, 11 (1989): 47–51; Hill, C.S. Jr., “The Negative Influence of Licensing and Disciplinary Boards and Drug Enforcement Agencies on Pain Treatment with Opioid Analgesics,” Journal of Pharmaceutical Care in Rain and Symptom Control, 1, no. 1 (1993): 43–62; Foley, K.M. and Gelband, H., eds., Institute of Medicine National Cancer Policy Board, Improving Palliative Care for Cancer (Washington, D.C.: National Academy Press, 2001), available at <http://www.nap.edu/catalog/10149.html>.Google Scholar
Washington State Medical Disciplinary Board, Bulletin to Physicians: Chronic Pain (1987).Google Scholar
State of Washington Department of Health, Policy Statement (1989).Google Scholar
State of Washington Department of Health, Policy Statement to the Washington State Medical Disciplinary Board: Guidelines for Opiate Usage (1992): At 1.Google Scholar
State of Washington Department of Health, Guidelines for Management of Pain (1996), available at <http://www.medsch.wisc.edu/painpolicy/domestic/wambguid.htm>..>Google Scholar
California Medical Board, “A Statement by the Medical Board,” Action Report, 50 (1994): 4–5, available at <http://www.medsch.wisc.edu/painpolicy/domestic/cambstmt.htm>; California Medical Board, “Guideline for Prescribing Controlled Substances for Intractable Pain,” Action Report, 51 (1994): 1, 8, available at <http://www.medsch.wisc.edu/painpolicy/domestic/cambguid.htm>; Joranson, D.E., “State Medical Board Guidelines for Treatment of Intractable Pain,” American Pain Society Bulletin, 5, no. 3 (1995): 1–5, available at <http://www.medsch.wisc.edupainpolicy/publicat/95apssm.htm>.Google Scholar
Federation of State Medical Boards of the United States, Model Guidelines for the Use of Controlled Substances for the Treatment of Pain (Euless, Texas: Federation of State Medical Boards of the United States, 1998), available through <http://www.fsmb.org>..>Google Scholar
Federation of State Medical Boards of the United States, Position of the Federation of State Medical Boards in Support of Adoption of Pain Management Guidelines (Euless, Texas: Federation of State Medical Boards of the United States, 2000), available at <http://www.medsch.wisc.edu/painpolicy/domestic/FSMBwp.htm>..>Google Scholar
Joranson, D.E. et al., 2001 Annual Review of State Pain Policies: A Question of Balance (Madison: Pain & Policy Studies Group, University of Wisconsin Comprehensive Cancer Center, 2002): At 2, available at <http://www.medsch.wisc.edu/painpolicy/publicat/01annrev/contents.htm>.Google Scholar
Joranson, D.E. et al., Achieving Balance in Federal and State Pain Policy: A Guide to Evaluation (Madison: Pain & Policy Studies Group, University of Wisconsin Comprehensive Cancer Center, 2000): At 13–17, available at <http://www.medsch.wisc.edu/painpolicy/eguide2000/index.html>.Google Scholar
Idaho State Board of Medicine, “Prescribing Opioids for Chronic Pain,” State Pamphlet (March 1995), available at <http://www.medsch.wisc.edu/painpolicy/domestic/idmbguid.htm>..>Google Scholar
See Federation of State Medical Boards, supra note 8, at 2.Google Scholar
House of Delegates of the Federation of State Medical Boards (May 1998).Google Scholar
See Federation of State Medical Boards, supra note 9.Google Scholar
See California Medical Board, supra note 7.Google Scholar
See Joranson, et al., supra note 11, at 18.Google Scholar
National Conference of Commissioners on Uniform State Laws, Uniform Controlled Substances Act (of 1990); National Conference of Commissioners on Uniform State Laws, Uniform Controlled Substances Act (of 1994), available at <http://www.law.upenn.edu/bll/ulc/fnact99/1990s/ucsa94.pdf>..>Google Scholar
See Joranson, et al., supra note 11.Google Scholar
Joranson, D.E., Gilson, A.M., and Nischik, J.A., “North Carolina, Pain Management and End-of-Life Care: Communicating the Policy,” Federation Bulletin: Journal of Medical Licensure & Discipline, 88, no. 3 (2002): 116–19, available at <http://www.medsch.wisc.edu/painpolicy/publicat/02fsmb/index.htm>.Google Scholar
Maryland Board of Physician Quality Assurance: A Sense of Balance — Treating Chronic Pain, produced by Maryland Public Television: Special Projects Unit, 20 min. (1998), videocassette.Google Scholar