Source: Provided by the American Alliance of Cancer Pain Initiatives
Effective date: December 7, 2005

The Wisconsin Pharmacy Examining Board
Position Statement on the Treatment of Pain

The mission of The Wisconsin Pharmacy Examining Board is to promote, preserve and protect the public health, safety and welfare by fostering provision of quality pharmaceutical care to all Wisconsinites. The Board recognizes quality care dictates the citizens of the State of Wisconsin have access to appropriate and effective pain relief. The appropriate application of current knowledge, practice standards and treatment modalities can serve to improve the quality of life for those patients who suffer from pain. This in turn will reduce the morbidity and costs associated with untreated or inappropriately treated pain. The Board encourages pharmacists to view effective pain management as a part of quality care for ALL patients with pain, acute or
chronic. It is especially important for patients who experience pain as a result of terminal illness. All pharmacists should become knowledgeable about effective methods of pain treatment, as well as, statutory requirements for dispensing controlled substances.

Inadequate pain control may result from physicians’ and pharmacists’ lack of knowledge about pain management or an inadequate understanding of addiction. The Board recognizes controlled substances, including opioid analgesics, may be essential in the treatment of pain, whether acute due to trauma or surgery or chronic due to cancer or non-cancer origins.

The Board recognizes controlled substances are subject to abuse by individuals who seek them for mood altering and other psychological effects rather than their legitimate medical uses. When dispensing controlled substances, the pharmacist should be diligent in preventing them from being diverted from legitimate to illegitimate use.

Tolerance and physical dependence are normal consequences of sustained use of these drugs and are NOT synonymous with psychological dependency (addiction). Psychological dependency is characterized by the compulsion to take a drug despite its harmful and destructive effect on the individual. Tolerance represents a secondary medical condition requiring pharmacy and medical assistance to resolve and continue patient pain control. Psychological dependency requires social (regulatory), plus pharmacy and medical assistance to maximize patient care while controlling the harmful and destructive patient behavior.

As with all medication therapies, the Board affirms the pharmacist’s duty to provide medications along with proper counseling to ensure pain control. Failure to:

a) counsel, monitor and assist the patient in receiving optimal care of any condition or,
b) knowingly facilitating care, continuing care or providing medications known to be inappropriate to the patient

is unprofessional practice with the possibility of discipline under various Board rules plus Wisconsin and Federal Regulations. IE, controlled substances shall only be dispensed for legitimate medical purposes.

By participating as a member of the health care team, Pharmacists should NOT fear disciplinary action from the Board for dispensing controlled substances, including opioid analgesics, for a legitimate medical purpose in the usual course of professional practice. The Board will initially consider dispensing controlled substances for pain to be for a legitimate medical purpose based on accepted scientific knowledge of the treatment of pain, patient clinical presentation and sound clinical judgment. All such dispensing must be based on clear documentation in the patient’s pharmacy records of the patient’s medical condition plus pertinent discussions with the prescribing practitioner. Using proper written documentation, the patient’s medical condition and
clinical response to treatment provide a strong foundation for verifying optimal patient care, if review of the patient record is necessitated at some future time.