AMERICAN PAIN INSTITUTE,
ARKANSAS CHAPTER
In the last decade,
efforts by a variety of individuals, cancer pain initiatives, patient groups
(such as ours) and state agencies have begun to reform state pain policy. In most cases, these changes have produced
more balanced state policies.
State Intractable
Pain Treatment laws are intended to improve access to pain management. However, these policies may exclude patients
whose pain does not satisfy the definition of “Intractable Pain”, and they
typically do not contain provisions or funding that is needed to achieve better
pain management. IPTAs often pose more
requirements and restrictions on the prescribing of opioids for pain, and many
states have chosen to develop guidelines or regulations instead.
From 1994 to 1998,
state medical boards participated in pain management workshops sponsored by the
PPSG and the Federation of State Medical Boards of the U.S. and have begun adopting guidelines (and in a
few cases, regulations) to encourage improved pain management and to dispel
physicians’ fear of discipline. To
promote consistency in state medical policy, the FSMB adopted in 1998 “Model
Guidelines for the Use of Controlled Substances for the Treatment of
Pain.” We need to fight to continue the
trend to adopt state medical board policy statements on pain management which
may in turn affect both pharmacy and nursing practice regulations. We have the power, through constructive
actions, to contribute to changes in our state pain-related laws, regulations
and other policies.
In addition to
federal policy, the prescription, dispensing, and administration of drugs,
including controlled substances, is regulated by the states. States are responsible for regulating
medical, pharmacy, and nursing practices.
State policies are not as balanced as international and federal policy
and this needs to be changed. Many
state laws, including those in Arkansas, do not recognize the medical value of
controlled drugs as does federal law.
States also have laws, regulations, or other governmental policies that
restrict prescribing and dispensing of opioids more than federal policy; such
policies often have the potential to interfere with decisions about the care of
individual patients that require medical expertise rather than government
dictum.
Beginning in
Wisconsin in the mid-1980’s, studies by various groups and individuals have
identified regulatory impediments to pain management in state policies. The impediments include lack of legal
recognition of the medical value of opioids, limitations on prescribing and
dispensing, exclusion of substance abusers from prescriptions for pain
medications, and a variety of others including terminology that confuses
physical dependence with addition. Many
of these restrictive provisions in state policies date back 25 years or more,
and appear to be based on now outdated knowledge about pain, opioids and
addiction.
All of this information
contributes to our coalition objective:
We believe that a patient’s medical care should be mandated between
themselves and their personal family care physician. We believe that a patient’s medical care is confidential in
nature and should be kept as such. We
feel that patients and physicians should be afforded every avenue available to
deal with medical conditions/diseases/ailments and restore the patients quality
of life. We feel that the course of
action/treatment chosen to help the individual patient should not be able to be
mandated by a third party unrelated and/or unfamiliar with the patient’s
case. We strongly feel that the
patient’s personal family care physician should not be threatened and/or
discouraged from utilizing the best treatment and/or medication currently
available to restore his/her patient’s quality of life. Our number one goal is to get the INTRACTABLE
PAIN TREATMENT ACT introduced into legislation and passed into law in the
State of Arkansas. This will allow both
the patient and their personal family care physician to proceed with their
medical care without fear of repercussion and ultimately put the decision
making factor back where it belongs.