Most states said to have good rules on pain medicines

Forty-four states now merit a grade of "C" or higher for policies that support appropriate medical use of opioid analgesics while controlling diversion and abuse, according to a report card published in July by the University of Wisconsin Pain & Policy Studies Group.

The report is the fifth by the group since 2000, when 24 state policies earned a "C" or better. Seven states saw their grades improve from 2007 to 2008, and no state's grade has worsened since 2000. Five states -- Kansas, Michigan, Oregon, Virginia and Wisconsin -- have "A" grades.

To rate state pain policies, analysts evaluated 16 criteria, such as whether medical use of opioids is explicitly recognized as legitimate professional practice, or whether standards for prescribing are arbitrary.

"This is right in line with previous years' reports in that it reflects a continued, steady improvement and policies that are continuing to become more balanced," said Martha Maurer, a UW policy analyst who helped produce the report.

A "major contributor to progress in recent years," Maurer said, is the Federation of State Medical Boards' model policy for controlled substances in treating pain. The policy, adopted in 2004, noted barriers to appropriate pain treatment; said government is obliged to combat drug diversion and ensure legitimate access; revised outdated definitions of addiction, chronic pain and physical dependence; and updated criteria for evaluating pain management.

Lisa Robin, FSMB senior vice president, said medical boards have not made policy changes on their own. "We've seen a number of states where they form initiatives and bring together all the different regulatory groups -- law enforcement, all the boards -- as well as patient groups and address these issues and look at it broadly," Robin said.

Another trend making it easier to stop so-called doctor-shopping is the establishment of prescription monitoring programs. As of June, 38 states had PMPs, according to the Alliance of States with Prescription Monitoring Programs. The programs usually give electronic access to prescription records to law enforcement, health officials, physicians and pharmacists, allowing them to spot patients who may be forging prescriptions or obtaining opiods from multiple doctors.

The AMA has backed congressional proposals to help states fund electronic PMPs because they give doctors access to patient information, but the AMA has policy opposing multiple paper-copy prescription monitoring programs as ineffective.