This post is meant to be a guide or resource for individuals searching for information on laws and regulations in their state which govern the practice of pain management and prescribing of controlled substances. This is a work in progress and with 50 States, there are several hundred documents which must be tracked down. If you have a pressing matter which needs immediate assistance for a specific state, contact Randall Carter or Caludia Merandi on the DPPR website or via email at CERGM. Links provided in this post were current as of Janruary 2020, some document links in the table below, may have broken links, primarily because states change document locations frequently, which result in a dead links. If you find information not included in this post and wish to share it, follow the links above to forward that information.
Since 1999 efforts to recognize distinct population groups and the differences between them, when using opioids to treat non-cancer chronic pain and efforts used to combat opioid abuse, have had few if any recognizable differences. Patient populations for both groups have been lumped under a single category for combating opioid abuse and addiction. Chronic pain treatment being an after thought with little regard for the actual impact on patients and the consequences they might suffer.
Reducing the supply side of opioids has been an almost singular perspective in the efforts to slow abuse, addiction and overdose deaths, but such actions have unintended consequences. With prescription opioid production now cut by 50% since 2013, critical care facilities now have routine shortages of essential medications needed to treat injuries and disease, combined with law enforcement efforts to curb prescribing for chronic pain conditions, it's rare to find anyone treated with opioids who's not experienced a forced taper or termination of essential medications.
The results have been horrific with millions of American's suffering a wide range of difficult consequences. Loss of functionality resulting in decreased quality of life, loss of employment and earned income, with some individuals becoming home bound or bed bound and still others, committing suicide rather than face the day to day existence of constant and unbearable pain.
The other component of these efforts has been directed at physicians, but since law enforcement has no jurisdiction on how medicine is practiced, law enforcement has pitted doctor against doctor by using paid consultants to judge the efforts of other prescribing doctors. Those deemed to be high prescribers are prosecuted to the full extent of the law, instilling fear of prosecution and loss of assets through asset forfeiture in those that remain. This latter approach has been wildly successful over the last 20 years and has eliminated as many as 60% of the doctors who once prescribed opioids for chronic pain conditions. The other phase of these efforts was to provide falsified data and opinion through the CDC on treating long term chronic pain, providing justification for State Medical Boards to override FDA prescribing guidelines by setting fixed limits based on Morphine Milligram Equivalents, regardless of patient age, sex, body mass or other comorbid conditions which complicate treating chronic pain.
With the financial support of DPPR members, now more than 12,000 individuals, DPPR is broadening it's efforts by establishing this web sight, The Doctor Patient Forum, to further the mission of helping doctors and patients return to a balanced approach of treating chronic pain. Methods which do not have as their primary or only goal of preventing opioid abuse and addiction. While acknowledging this as a possible complication, DPPR is seeking to restore the rights of physicians to practice pain management based on individual need, without the fear of undue legal complications of treating chronic pain advocated for by the 2016 CDC guidelines. The adoption of these guidelines by State Medical Boards for use by pain specialist as well as all other medical specialties, is a misapplication of the stated purpose of the guidelines.
To these ends, starting in 2020, DPPR will begin developing its legislative action plan to support the following mission goals.
- Helping Americans deal with chronic and consistent pain without undermining efforts to deter opioid abuse and overdose.
- Devise a legislative outreach plan to
- Open a dialogue with federal agencies such as CDC and DEA
- To recognize the proper use of pain medication on an individual basis and in those conditions where opioids provide a better outcome or fewer risks.
- Meet with pertinent congressional members to get an idea of what is happening in Washington.
- To identify and promote legislation which recognizes the greater benefits and lower risks associated with physician autonomy, in weighing treatment choices for chronic pain conditions.
- To reduce the stigma of fear currently hanging over prescriber decision making, regarding the use of opioids or amounts needed, when treating individuals.
Below is a letter from the Mayforth Group which has been retained by DPPR for these purposes. This letter represents the continued collective efforts of DPPR membership.
Don't Punish Pain Rally founder pushes hard for legislation: Follow this Link