Policy Issues and Imperatives in the Use of Opioids to Treat Pain in Substance Abusers

Melzack R. , “The Tragedy of Needless Pain: A Call for Social Action,” Scientific American, 262, no. 2 (1988): 27–33.

Dahl J.L. Joranson D.E. , “Cancer Pain: The US Responds,” Palliative Medicine, 6 (1992): 94–97.

Agency for Health Care Policy and Research, Acute Pain Management: Operative or Medical Procedures and Trauma, Clinical Practice Guideline (Rockville: U.S. Department of Health and Human Services, 1992); and Jacox A. Carr D.B. Payne R. , Management of Cancer Pain, Clinical Practice Guideline No. 9 (Rockville: U.S. Department of Health and Human Services, Public Health Service, 1994).

See Melzack , supra note 1; Cleeland C.S. Gonin R. Hatfield A.K. , “Pain and Its Treatment in Outpatients with Metastatic Cancer,” The New England Journal of Medicine, 330 (1994): 592–96.

See Cleeland , supra note 4.

See Jacox , supra note 3.

Cleeland C.S. , “Barriers to the Management of Cancer Pain,” Oncology, 1 Supp. (1987): 19–26; and see Jacox , supra note 3.

Portenoy R.K. , “Chronic Opioid Therapy in Nonmalignant Pain,” Journal of Pain and Symptom Management, 5, no. 1, Supp. (1990): S46–S62; World Health Organization Expert Committee, Cancer pain Relief and Palliative Care (Geneva: WHO, 1990); Weissman D.E. Joranson D.E. Hopwood M.B. , “Wisconsin Physicians' Knowledge and Attitudes About Opioid Analgesic Regulations,” Wisconsin Medical Journal, 90 (1991): 671–75; Hill C.S. , “The Negative Influence of Licensing and Disciplinary Boards and Drug Enforcement Agencies on Pain Treatment with Opioid Analgesics,” Journal of Pharmaceutical Care in Pain & Symptom Control, 1 (1993): 43–62; and see Jacox , supra note 3.

See World Health Organization Expert Committee, supra note 8.

World Health Organization, Cancer Pain Relief (Geneva: WHO, 1986); Joranson D.E. , “Federal and State Regulation of Opioids,” Journal of Rain and Symptom Management, 5 (1990): S12–S23; Angarola R.T. , “National and International Regulation of Opioid Drugs: Purpose, Structures, Benefits and Risks,” Journal of Rain and Symptom Management, 5, no. 2, Supp. (1994): S6–S11; see Jacox , supra note 3; and Shapiro R.S. , “Legal Bases for the Control of Analgesic Drugs,” Journal of Pain and Symptom Management, 9, no. 3 (1994): 153–59.

See World Health Organization Expert Committee, supra note 8.

Daut R.L. Cleeland C.S. , “The Prevalence and Severity of Pain in Cancer,” Cancer, 50, no. 9 (1982): 1913–18; see World Health Organization, supra note 10; International Narcotics Control Board, Report of the International Narcotics Control Board for 1989 (Vienna: United Nations, INCB, 1989); and Cleeland C.S. Ryan K.M. , “Pain Assessment: Global Use of the Brief Pain Inventory,” Annals of the Academy of Medicine, 23, no. 2 (1994): 129–38.

Ferrell B. , “Cost Issues Surrounding the Treatment of Cancer Related Pain,” Journal of Pharmaceutical Care in Pain & Symptom Control, 1 (1993): 9–12; and 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.

Narcotic is a legal term that includes other substances, such as cocaine and marijuana, and is used in a legal context. Opioid is a pharmacological term, and is used to refer to codeine, morphine, and other natural and synthetic drugs whose effects are mediated by specific receptors in the central and peripheral nervous systems.

Angarola R.T. Wray S.D. , “Legal Impediments to Cancer Pain Treatment,” in Hill C.S. Fields W.S. , eds., Advances in Pain Research and Therapy, Vol. 11 (New York: Raven Press, 1989), pp. 213–31; and see Joranson , supra note 10.

Weissman D.E. Haddox J.D. , “Opioid Pseudoaddiction—An Iatrogenic Syndrome,” Pain, 36 (1989): 363–66.

Federation of State Medical Boards of the United States, A Guide to the Essentials of a Modern Medical Practice Act, 5th ed. (Forth Worth: FSMB, 1988).

Federal Register, 48 (1983): 2673.

Federal Register, 40 (1975): 15393–94.

U.S. v. Evers, 453 F. Supp. 1141 (M.D. Ala. 1978) aff'd F.2d 1043 (5th Cir. 1981).

Controlled Substances Act, Pub. L. No. 91–513, 84 Stat. 1242 (1970); Drug Enforcement Administration, Physician's Manual: An Informational Outline of the Controlled Substances Act of 1970 (Washington, D.C.: U.S. Department of Justice, DEA, 1990).

Federal Register, 51 (1986): 17476–78; and Joranson D.E. Cleeland C.S. Weissman D.E. Gilson A.M. , “Opioids for Chronic Cancer and Non-Cancer Pain: A Survey of State Medical Board Members,” Federation Bulletin: The Journal of Medical Licensure and Discipline, 79, no. 4 (1992): 15–49.

See Controlled Substances Act, supra note 21.

21 C.F.R. § 801a(3) (1988), p. 836.

U.S. v. Moore, 423 U.S., 122 (1975).

21 C.F.R. § 1306.07(a) (1988).

Webb et al. v. U.S., 249 U.S., 96 (1919).

See Controlled Substances Act, supra note 21.

21 C.F.R. § 1306.07(c) (1988), p. 72.

21 C.F.R. § 802(1) (1988), p. 836.

Jaffe J.H. , “Misinformation: Euphoria and Addiction,” in Hill C.S. Fields W.S. , eds., Advances in Pain Research and Therapy, Vol. 11 (New York: Raven Press, 1989), pp. 163–74; Morgan J.P. , “American Opiophobia: Customary Underutilization of Opioid Analgesics,” in Hill C.S. Fields W.S. , eds., Advances in Pain Research and Therapy, Vol. 11 (New York: Raven Press, 1989), pp. 181–89; Ferrell B.R. McCaffery M. Rhiner M. , “Pain and Addiction: An Urgent Need for Change in Nursing Education,” Journal of Pain and Symptom Management, 7, no. 2 (1992): 117–12; and Joranson D.E. , “Fear of Addiction is an Impediment to Cancer Pain Relief: A Proposal to the World Health Organization Programme on Substance Abuse,” Symptom Control in Cancer Patients, 5 (1993): 52–58 (Japanese article).

See Joranson , supra note 31.

World Health Organization, WHO Expert Committee on Drug Dependence: Sixteenth Report (Geneva: WHO, 1969).

World Health Organization, WHO Expert Committee on Drug Dependence: Twenty-Eighth Report (Geneva: WHO, 1993).

American Pain Society, Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain (Skokie: APS, 3rd ed., 1992).

21 C.F.R. § 291.505(a)(5) (1988).

Ibid.

See Joranson , supra note 10, p. S16.

Federal Register, 58 (1993): 37507–08.

Ibid., p. 37507.

See Federation of State Medical Boards of the United States, supra note 17.

Ibid., p. 2.

Alabama State Board of Medical Examiners, § 1306.07(c) (1986).

California Senate Bill, No. 1802, ch. 1588 (1990).

New Jersey Board of Medical Examiners Regulations, 13:35–6.6(g) (1985).

Texas Medical Practice Act, § 5, art. 4495c, § 2(3) (1992).

Virginia Pharmacy Act, § 54.1–3408.1 (1989).

Alabama State Board of Medical Examiners, supra note 43, p. 18.

Federation of State Medical Boards of the United States, supra note 41, pp. 14–15.

California Uniform Controlled Substances Act, § 11156 (1989).

Indiana Medical Licensing Board, art. 22.5, ch. 6, 25–22.5-6-2.1, § 21(7) (1987).

New York Administrative Rules and Regulations, pt. 80, § 80.85(a).

Tennessee Division of Health Related Boards, ch. 6, pt. 2, 63-6-214(13) (1989).

Texas Medical Practice Act, subch. C, § 3.08(4c) (1992).

Utah Controlled Substances Rules, R153-37-8(A8) (1988).

Wyoming Medical Practice Act, ch. 26, art. 1, § 33-26-402(a, xi) (1987).

Tennessee Division of Health Related Boards, supra note 53, p. 9.

See California Uniform Controlled Substances Act, supra note 50, p. 31.

Weissman D.E. , “Do Drug Regulations Affect Medical Practice?,” Journal of Pain and Symptom Management, 7 (1992): 257–58; and see Hill , supra note 8.

See Joranson , supra note 22.

National Conference of Commissioners on Uniform State Laws, Uniform Controlled Substances Act (St. Louis: NCCUSL, 1970).

See Joranson , supra note 10.

Ibid.

New York State Public Health Law, art. 33, tit. 1, § 3302(1), p. 467.

Maryland Pharmacy Act, art. 27, § 277(n) (1985), p. 41.

See Joranson , supra note 10.

Montana Board of Pharmacy, Statutes and Rules, 37-2-111(2) (1988), p. 26.

See Weissman Haddox , supra note 16.

Tennant F. , “The California Registration System for Habitues to Schedule II Drugs,” in Harris L.S. , ed., Problems of Drug Dependence: Proceedings of the 42nd Annual Scientific Meeting of the Committee on Problems of Drug Dependence (Washington, D.C.: U.S. Government Printing Office, 1981).

Macaluso C. Weinberg D. Foley K.M. , “Opioid Abuse and Misuse in a Cancer Pain Population,” Journal of Pain and Symptom Management, 3 (1988): S541; Hoffman M. Provatas A. Lyver A. Kanner R. , “Pain Management in the Opioid-Ad-dicted Patient with Cancer,” Cancer, 68 (1991): 1121–22; Fishbain D.A. Rosomoff H.L. Rosomoff R.S. , “Drug Abuse, Dependence, and Addiction in Chronic Pain Patients,” Clinical Journal of Pain, 8 (1992): 77–85; and Gonzales G.R. Coyle N. , “Treatment of Cancer Pain in a Former Opioid Abuser: Fears of the Patient and Staff and Their Influence on Care,” Journal of Pain and Symptom Management, 7 (1992): 246–49.

The NIDA technical review, at which this paper was presented, provided a consensus that, while the medical use of controlled substances to treat pain in a substance abuser may be complex, nevertheless, it is a legitimate medical purpose.

Journal of Pain and Symptom Management, 8, no. 5 (1993): 253–319.

National Conference of Commissioners on Uniform State Laws, Uniform Controlled Substances Act (Milwaukee: NCCUSL, 1990).

Joranson D.E. , “A New Drug Law for the States: An Opportunity to Affirm the Role of Opioids in Cancer Pain Relief,” Journal of Pain and Symptom Management, 5, no. 5, Supp. (1990): 333–36.

Washington Controlled Substances Act, Pub. L. No. 69.50.308(g) (1993).

See Jacox , supra note 3.

Correspondence from Rettig Richard A. , Ph.D., to Joranson David E. , dated November 17, 1993.

Correspondence from Dale Breaden to Joranson David E. , dated November 18, 1993.

Angarola R.T. Joranson D.E. , “California Sponsors Pain Summit; Maryland Fends Off New Regulations,” APS Bulletin, 4, no. 3 (1994): 11–12.

Medical Board of California, “Prescribing Controlled Substances for Pain: A Statement by the Medical Board of California,” May 6, 1994.

Medical Board of California, “Guideline for Prescribing Controlled Substances for Intractable Pain,” July 29, 1994.

Ibid.

California Board of Registered Nursing, “Pain Management Policy,” April 1994.