Magazine article Clinical Psychiatry News

DEA Guidelines Clarify Issues of Opioid Use and Misuse

Magazine article Clinical Psychiatry News

DEA Guidelines Clarify Issues of Opioid Use and Misuse

Article excerpt

Physicians who appropriately prescribe opioids to treat chronic pain can rest assured that they will not be investigated by federal agents, according to new guidelines for pain management issued jointly by the Drug Enforcement Agency and national pain experts.

But the guidelines also stress that physicians have to make sure that their patients aren't "doctor shopping" to hoard the drugs for personal use or illegal sale.

The document, "Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel," will be distributed to both physicians who prescribe opioids and DEA field agents. Its question and answer format includes guidelines on diagnosing pain, assessing patients' risk for addiction, and proper documentation. They also include information on laws and regulations, and clear descriptions of how and why the DEA may prosecute a prescriber.

The guidelines are an attempt to "strike a balance" between physicians' need to feel safe when prescribing these drugs and DEA's need to aggressively investigate allegations of drug diversion and fraud, said David Joranson, senior scientist and director of the Pain and Policy Studies Group (PPSG) at the University of Wisconsin, Madison. Medical and law enforcement personnel have "symmetrical responsibilities," in the issue, Mr. Joranson said during a press conference. "Prescribers have a responsibility not to contribute to abuse, and the DEA has a responsibility not to interfere with patient care."

About 40% of patients with chronic pain are undertreated, said Dr. Russell Portenoy, the project's lead pain expert. This is partly because of physicians' lack of knowledge of these drugs and their inability to accurately assess pain patients. "Physicians tend to overestimate the risks [associated with opioids] and accept the stigma that has evolved around these drugs, so the inference is that they are used much less than they should be in these populations," said Dr. Portenoy of Memorial Hospital for Cancer and Allied Diseases, New York.

Another factor in undertreatment is physicians' fear of investigation, Mr. Joranson said. "The medical and regulatory environment for pain management seems to be worsening. …

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