Unbalanced and misleading media coverage on the abuse of opioid
analgesics not only perpetuates misconceptions about pain management; it
also compromises the access to adequate pain relief sought by over 75
million Americans living with pain.
In the past several years, there has been growing recognition by health
care providers, government regulators, and the public that the
under-treatment of pain is a major societal problem.
Pain of all types is under-treated in our society. The pediatric and
geriatric populations are especially at risk for under-treatment.
Physicians’ fears of using opioid therapy, and the fears of other
health professionals, contribute to the barriers to effective pain
In 2001, in an unprecedented collaboration, the US Drug Enforcement
Administration (DEA) joined 21 Health Groups, including the American
Medical Association, in calling for balanced policy governing
prescription pain medications. In August 2004, the DEA issued a document
entitled Prescription Pain Medications: Frequently Asked Questions and
Answers for Health Care Professionals and Law Enforcement Personnel,
however, the agency withdrew its support for the document less than 2
months later saying that it "contained misstatements" and
"was not approved as an official statement of the agency."
The AMA supports the position that (1) physicians who appropriately
prescribe and/or administer controlled substances to relieve intractable
pain should not be subject to the burdens of excessive regulatory
scrutiny, inappropriate disciplinary action, or criminal prosecution. It
is the policy of the AMA that state medical societies and boards of
medicine develop or adopt mutually acceptable guidelines protecting
physicians who appropriately prescribe and/or administer controlled
substances to relieve intractable pain before seeking the implementation
of legislation to provide that protection; (2) education of medical
students and physicians to recognize addictive disorders in patients,
minimize diversion of opioid preparations, and appropriately treat or
refer patients with such disorders; and (3) the prevention and treatment
of pain disorders through aggressive and appropriate means, including
the continued education of physicians in the use of opioid preparations.
The Federation of State Medical Boards’ Model Guidelines for the Use
of Controlled Substances for the Treatment of Pain, encourage adequate
pain management and address physician concerns about disciplinary
actions by medical boards. These guidelines were recently updated to
ensure currency and adequate attention to the treatment of pain.
Policies and guidelines of the American Pain Society, the American
Academy of Pain Medicine, the American Geriatric Society, and the
American Society for Addiction Medicine also encourage the appropriate
use of opioid analgesics for pain management.
At its annual policy-making meeting in the summer of 2003, the AMA House
of Delegates adopted policy recommendations stating their opposition to
the harassment of physicians by DEA agents in response to the
appropriate prescribing of controlled substances for pain management, as
well as to the inappropriate use of 21 Code of Federal Regulations
Section 1306.04 or any other rationale that would involve placement of
licensure restrictions on physicians who use opioid analgesics and other
pain-reducing medications appropriately to treat patients with pain. The
AMA requests that state medical and specialty societies submit examples
of physicians who allegedly have been harassed by DEA agents for
appropriate prescribing of controlled substances for pain management to
the AMA's Office of General Counsel.
The AMA is committed to the goal of protecting the legitimate use of
prescription drugs for patients in pain. And education is the best
medicine. To this end, the AMA has created a national Pain Management
CME program for physicians to address many of these issues. The review
board for this activity consists of expert reviewers from 16 medical
specialty societies and other professional health care organizations.
The CME program was funded through an unrestricted educational grant
from Purdue Pharma, L.P.
In addition, the American Academy of Pain Medicine recently announced a
new initiative, named TOP MED (Topics in Medicine), a comprehensive
"virtual textbook" on treating patients of all ages suffering
from different types of pain. The web-based, self-directed textbook will
be made available free of charge to medical students across the country
in the fall of 2004.
Preventing drug abuse remains an important societal goal—it should
not hinder patient’s ability to receive the care they need and deserve
or discourage physicians from prescribing pain medications when