Opinion

Schedule II drug rule only a first step

A DEA-proposed regulation will help physicians with one aspect of pain prescribing, but more needs to be done.

Posted Oct. 16, 2006.

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Doctors shouldn't feel unnecessarily constrained when they go to put pen to prescription pad to help a patient who is legitimately in chronic pain.

Unfortunately, though, all too often that can be the case, given special government restrictions on how some prescriptions may be written. On top of that, there's a fear in the back of many physicians' minds that they could be investigated for prescribing too many pain medications, even if the scripts they write are legitimate.

But one of those aspects is about to get a little easier for doctors.

The Drug Enforcement Administration in September proposed a rule that would let doctors write multiple prescriptions for schedule II drugs during a single office visit, with the total amount prescribed not allowed to exceed a 90-day supply.

It's something doctors were able to do before the DEA created an interim policy in 2004 that said writing multiple prescriptions with instructions to fill the prescriptions on different dates was the equivalent of authorizing refills of a schedule II drug. The Controlled Substances Act makes refills for those drugs illegal.

Returning to a policy that lets doctors use their professional judgment to decide if refills on prescription pain medication are appropriate for their patients' care will help ensure that patients receive the care they need without the added inconvenience and cost of repeated physician office visits.

The proposed rule change -- open for comment until Nov. 6 -- makes it easier for doctors to help patients. But more needs to be done to alleviate physician concerns about the DEA investigating their prescribing.

The DEA says that it only prosecutes a small number of physicians for pain prescriptions, but doctors say it is tough to know what exactly may trigger an investigation. That leaves them to worry that they will encounter problems despite writing only legitimate prescriptions.

There needs to be an ongoing discussion between the DEA and physician groups to help ensure that clinical practice environments are conducive to pain management -- an environment in which patients are appropriately treated for their pain, while drug abuse and diversion is minimized.

The DEA also needs to work with medical specialty societies and patient advocacy groups to promulgate a rational, realistic set of frequently asked questions to help educate doctors and other health professionals, law enforcement officials and regulatory personnel about appropriate pain management and measures to be taken to minimize drug abuse and diversion.

This will help doctors do their jobs without fear when they pick up their prescription pads.

Physicians are educated to make sure they are appropriately prescribing and that they can recognize addictive disorders in patients, minimize diversion of opioid preparations and appropriately treat or refer patients with disorders. The AMA is committed to making sure that physicians keep up to date on that information through its pain management continuing medical education program. And physicians have been eager to learn, with more than 53,000 physicians earning credit in the past few years. Also, physicians have requested 100,000 copies of the four-part AMA pain management monograph series.

The fact that doctors relieve suffering while doing everything they can to prevent the abuse of controlled substances reflects appropriate patient care. To do that when a strong patient-physician relationship exists requires that patients with legitimate needs have access to medication.

The recent DEA proposal helps patients have access to the care they need. Now the dialogue between doctors and DEA officials needs to continue, to ease doctors' worries that they may be investigated for putting their John Hancock on those legitimate prescriptions.

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External links

American Medical Association's national continuing medical education program, "Pain Management: The Series" (link)

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