Pain Management

Chronic Pain Management: Legal And Medical Aspects With Prescription Drug Abuse Prevention

Prescription Drug Abuse Prevention

Prescription Drug Abuse has different effects depending on the severity of the abuse. As such, prescription drug abuse prevention needs to be flexible to deal with this changing severity. Christensen Law is well-versed in healthcare laws of Oklahoma and the history behind chronic pain management. Here’s an article we wrote to explain a little more about this tricky subject.

Written by: Blake Christensen, DO, Adam W. Christensen, JD, MBA, S. Sandy Sanbar, MD, PhD, JD, D. Wade Christensen, JD, J. Clay Christensen, JD, L. Nazette Zuhdi, JD, LLM, Oklahoma City

Controlled substances prescription abuse has been reported to be the fastest growing drug problem in the United States. Since 2003, more overdose deaths have involved opioid analgesics than heroin and cocaine combined.* And, for every unintentional overdose death related to an opioid analgesic, nine persons are admitted for substance abuse treatment. In 1914, the Harrison Narcotic Tax Act was the first narcotics law that prohibited doctors from prescribing opioids to addicts. In 1970, the Controlled Substances Act replaced the Harrison Act as the federal U.S. drug policy under which manufacture, importation, possession, use and distribution of certain substances is regulated. In 2005, President George Bush promoted quality pain relief with accountability by signing NASPER (National All Schedules Prescription Electronic Reporting) into law. NASPER was designed to improve patient access and prevent “doctor shopping” and drug diversion.**

In 2007, the Food and Drug Administration Amendments of 2007 gave the FDA the authority to require a Risk Evaluation and Mitigation Strategy (REMS) from manufacturers to ensure the benefits of a drug outweighed its risks through education of providers and the public. In 2009, the FDA announced a “Safe Use Initiative,” a program aimed at decreasing the likelihood of preventable harm from medication use. Finally, in 2011, President Barack Obama’s administration unveiled a Prescription Drug Abuse Prevention Plan, which focuses on four major areas: education, monitoring, enforcement, and disposal. There are also state laws, rules, policies and guidelines that address proper pain management.

The means of narcotic control is found within the federal and state laws currently in place, together with a three step-wise methodological approach to treatment from providers according to their trained skill set.***

1. The first modality is via prevention, patient education and screening. Primary care physicians and other interdisciplinary care providers play a vital role in effective treatment of chronic pain. The chronic-pain patients receiving treatment in this modality are typically the least physically and psychologically impaired. The physician should follow all existing regulations and evidence-based guidelines while having an individualized treatment plan for each patient. This level is typically the most cost-effective modality of treatment for the patient. It is also the modality where most of the laws governing controlled substances apply.

2. The second modality involves physicians who are board-certified in interventional pain management. The patients in this category are complex and display little or no progress using more conservative treatment. Interventional pain procedures can involve high-risk procedures and should only be provided by designated board-certified specialists when stringent objective medical criteria are met. These patients will often require an interdisciplinary care team and manager. They may need the help of a board-certified surgical specialist.

3. The third modality of treatment involves patients with the most physical and psychological impairment. It requires an interdisciplinary team. Psychiatric counseling may be beneficial. The patient should understand all facets of the ailment, have the support of family and friends, and have an established care team manager and interdisciplinary care team. Families need to be good reporters about the patient.

Treatment should focus on ways to manage the disease. The practice of medicine and pain management is based on patient care within the confines of the law. The law protects society from the dangers of narcotic abuse. Public policy exists to protect the public. The crux of the patient, physician, lawmaker, and public interests lies in the efficacy of information exchange. By having a well informed society, effective pain management may be achieved and laws may be understood and followed. Through information exchange of all modalities and the public, a balance may be found between drug control and drug availability.

Prescription drug abuse prevention is the frontline tactic versus the fastest growing drug problem in America. If you have any questions about the legal side of prescription drug abuse, the lawyers at Christensen Law in OKC can help.

* http://www.cdc.gov/nchs/nvss.htm

**http://www.asipp.org/NASPER.htm

*** http://www.healthleadersmedia.com/HOM-75466-4625/Tiered-approachto-chronic-pain-targets-suffering