State medical boards seek to alter practice
Remove barriers to pain and symptom control
Many ethics committees have seen patient pain go undertreated as a consequence of physicians’ real or perceived fear of legal action. Now, a national effort will seek to reduce the legislative barriers that have led to this confusion and dilemma.
A survey of state medical board members demonstrates that they need updated information on opioids and pain management, says David E. Joranson, MSSW, director of Pain and Policy Studies Group at the University of Wisconsin Medical School in Madison. He tells Medical Ethics Advisor that all physicians need more education about pain management.
Targeting health care professionals
Joranson and colleagues are preparing an analysis of existing state medical board guidelines on pain medications. With support from the Princeton, NJ-based Robert Wood Johnson Foundation, the policy studies group will work over the next year with state medical boards and representatives of nursing and pharmacy boards to foster more informed decisions regarding professional practice in the treatment of pain.
"In our view, this issue should not be addressed through the state legislatures," he says. "Physicians are concerned that some legislative actions might actually further restrict access to opioids." For example, intractable pain treatment acts have been passed in some states and now include requirements that the use of opioids for intractable pain be "a therapy of last resort" or be used for pain "only in cases where the cause of pain cannot be removed."
His goal will be to develop a dialogue that focuses on ensuring that opioid use is based on patients’ needs, not regulatory concerns. Joranson favors adoption of simpler model intractable pain language that "neither affords immunity nor establishes restrictions but does clarify that it is legitimate medical practice to use opioids for intractable pain."1 Washington, Colorado, and Wisconsin have adopted such language as part of uniform controlled substance laws.
The project will include:
• science-based workshops and ongoing technical assistance for state medical boards;
• surveys of all 600 medical board members nationwide before and after the project to evaluate whether their attitudes toward opioid- prescribing are keeping pace with state-of-the art pain management;
• a national survey of pharmacists to assess their knowledge and attitudes about the use of opioids in pain management;
• a review of current data on whether opioids used to treat severe pain are part of the overall drug abuse problem;
• establishment of a resource database and World Wide Web site on pain management and pain policy.
Health care professionals should monitor the development of state pain policy closely now that the U.S. Supreme Court decision has shifted the focus on physician-assisted suicide to the states, Joranson says. He urges ethics committees to provide state officials and professionals in their own institutions with information about pain management and help in answering ethical questions.
"Health care professionals can have a substantial impact on removing real and perceived regulatory barriers to effective pain relief," he says.
Reference
1. Joranson DE and Gilson AM. The intractable pain policy: Current status. American Pain Society Bulletin 1997; March/April:7-9.
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