Understanding and Navigating the Laws and Regulations Governing Pain Relief With Opioids

Recent reports suggest that many healthcare practitioners express concern about prescribing controlled substances, including opioid analgesics, to patients with chronic pain, especially chronic noncancer pain.[1-4] Two of the primary causes of such concern are the reluctance to contribute to drug abuse, addiction, and diversion,[5-7] and the possibility of being investigated or disciplined by a regulatory agency.[6,8-10] Given the general dearth of specialists to whom patients with chronic pain can be referred, especially if the patient has a history of substance abuse or current addictive disease, many patients with pain remain untreated or undertreated. As a result, efforts to reduce the public health problem of prescription drug abuse can be viewed as exacerbating the public health problem of uncontrolled pain. Likewise, many believe that the call to treat pain has contributed to the recent increase in the nonmedical use of prescription drugs.