"Notice: this article appears on the PPSG website with the express
permission of the copyright holder, who should be consulted for
further permission to reproduce."
D.E. Joranson and A.M. Gilson, "Policy Issues and Imperatives in the Use of Opioids to Treat Pain in Substance
Abusers,"Journal of Law, Medicine & Ethics ,
22(1994): 215-23. (note: The first 3 paragraphs are reprinted with the permission of the American
Society of Law, Medicine & Ethics)
Policy Issues and Imperatives in
the Use of Opioids to Treat Pain in Substance
Abusers
David E. Joranson, Aaron M. Gilson
A great deal has been learned in the past fifteen years from the study of pain mechanisms.(1) More recently, the relief
of pain has begun to receive much needed attention as well.(2) Although most, if not all, acute and cancer pain can
be relieved,(3) recent evidence shows that inadequate treatment of pain is still common among the general population-even for pain due to cancer.(4) Inadequate treatment of cancer pain is even more likely if the patient is a member of
an ethnic minority, female, elderly, or a child.(5) Evidence also suggests that substance abusers are at risk for poor
pain treatment.(6)
A number of barriers which involve problems of knowledge, attitudes, and laws and regulations affect health care
professionals, patients, and the health care system; collectively, they contribute to the inadequate treatment of pain.
For example, practitioners prescribe opioids that are insufficient in strength, amount, or frequency due to lack of
knowledge, lack of concern about pain management, or fear of addiction.(7) However, reluctance to prescribe or
dispense opioids for intractable pain conditions can also be attributed to physicians' perceptions that they will be
investigated for violation of the laws or regulations that govern medical practice and controlled substances.(8)
Unfortunately, various federal and state laws, regulations, and other policies inappropriately or excessively regulate
the medical use of controlled substances, in particular, the opioids that are essential in pain management.(9) These laws
and regulations amount to legal barriers to pain management.(10) With accurate education and appropriate regulation,
the medical use of controlled substances can provide great improvements in the quality of life for millions of people
with debilitating medical conditions.(11) However, severe discomfort and distress are likely consequences if the
appropriate use of opioids for pain management is obstructed,(12) as are unnecessary hospitalizations and increased
health care costs.(13) Does the regulation of controlled substances and medical practice increase the risk that substance
abusers with pain will receive less than adequate pain management for painful conditions where opioids are indicated?
The purpose of this paper is to identify laws, regulations, and other policies that have the potential to interfere with
the appropriate prescribing of controlled substances to treat patients with pain, including substance abusers.
The holder of the copyright granted PPSG permission to post the first three paragraphs. The complete article is available from
the American Society of Law, Medicine and Ethics, 617 262 4990, aslme@bu.edu
