FEATURE
( continued from page 15 ) the CDC Guideline for direction , it is important they remain cognizant of the fact that , because the guideline is “ based on emerging evidence , including observational studies or randomized clinical trials with notable limitations ” ( REF 6 ), the CDC considers recommendations in the document to be voluntary :
“ The recommendations in the guideline are voluntary , rather than prescriptive standards .”
- Introduction , 2016 CDC Guideline for Prescribing Opioids for Chronic Pain
Similarly , our government ’ s top physician drug abuse researcher has weighed in on the CDC Guideline ( REF 6 ):
“ Although they are not rules that legally bind doctors in their treatment of pain patients , the guidelines provide valuable advice that physicians , who currently receive little training in pain management , will welcome .”
— Dr . Nora Volkow , Director , National Institute on Drug Abuse , April 06 , 2016
In addition , a recently published comprehensive review of a wide range of relevant prescribing guidelines ( including the CDC Guideline ) found little evidence to support the notion that any of our current guidelines should be viewed as beyond reproach ( REF 7 ).
“ Pain guidelines to date have been hindered by the paucity of quality clinical research in the area of pain management and must be interpreted and implemented within the context of the appreciable limitations of the data on which they are based . These recommendations should not be interpreted as a standard of care .”
- Drug and Alcohol Dependence , April 1 , 2017
Physicians are often judged by whether or not they practiced within the standard of care . The AMA Journal of Ethics has described the standard of care as “… a measure of the duty practitioners owe patients to make medical decisions in accordance with any other prudent practitioner ’ s treatment of the same condition in a similar patient ” ( REF 8 ). Regulations may be related to the standard of care but are not equivalent to the standard of care . Regulations are written by regulators - not necessarily by physicians ’ peers . Regulatory mandates often lag behind the evolution of what is considered to be current best practices . They also , among other limitations , can be based on low quality evidence ( REF 9 ). Nonetheless , to legally practice , medicine regulations must be followed .
CONCLUSIONS
Without a doubt , prescribing controlled substances is increasingly challenging for physicians . The burgeoning number of regulations , that differ significantly from jurisdiction to jurisdiction , can leave prescribers feeling vulnerable to legal or even criminal actions , making them reticent to prescribe adequately and further diminishing patients ’ access to adequate pain care ( REF 10 ). All physicians have a duty to alleviate suffering ( REF 11 ). When meeting this obligation includes prescribing controlled substances , Kentucky physicians must know the KBML regulations , follow the regulations , and clearly meet documentation requirements .
James Patrick Murphy , MD , MMM , a past-president of the Greater Louisville Medical Society , is the American Society of Addiction Medicine ’ s nominee to the new United States Department of Health and Human Services Pain Management Best Practices Inter-Agency Task Force .
References :
1 . 201 KAR 9:260 . Professional standards for prescribing and dispensing controlled substances . Kentucky Board of Medical Licensure ( As Amended at ARRS , October 10 , 2017 ) http :// www . lrc . ky . gov / kar / 201 / 009 / 260reg . htm
2 . Kentucky Board of Medical Licensure Newsletter , Fall 2017 https :// kbml . ky . gov / newsletter / Documents / 2017-04 % 20Fall . pdf
3 . Kentucky Board of Medical Licensure website https :// kbml . ky . gov / Pages / index . aspx
4 . KASPER ( Kentucky All Schedule Prescription Electronic Reporting ) http :// www . chfs . ky . gov / os / oig / KASPER . htm
5 . CDC Guideline for Prescribing Opioids for Chronic Pain — United States , 2016 Recommendations and Reports . March 18 , 2016 , 65 ( 1 ); 1 – 49 https :// www . cdc . gov / mmwr / volumes / 65 / rr / rr6501e1 . htm
6 . The CDC Provides Crucial New Guidance on Opioids and Pain , Nora Volkow , Nora ’ s Blog , National Institute on Drug Abuse , April 06 , 2016 https :// www . drugabuse . gov / about-nida / noras-blog / 2016 / 04 / cdc-provides-crucial-newguidance-opioids-pain
7 . Barth , Kelly S ., et al . Targeting practitioners : A review of guidelines , training , and policy in pain management . Drug and Alcohol Dependence . 173 ( APRIL 1 , 2017 ) https :// www . ncbi . nlm . nih . gov / pubmed / 28363316
8 . AMA Journal of Ethics Virtual Mentor . November 2005 , Volume 7 , Number 11 . http :// journalofethics . ama-assn . org / 2005 / 11 / hlaw1-0511 . html
9 . ACHIEVING BALANCE in State Pain Policy , A Progress Report Card ( CY 2013 ). Pain & Policy Studies Group , University of Wisconsin School of Medicine and Public Health , Carbone Cancer Center . www . painpolicy . wisc . edu July 2014
https :// www . acscan . org / sites / default / files / PRC-2013 . pdf
10 . Dineen , Kelly K . and James M . DuBois . Between a Rock and a Hard Place : Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanction ? Am J Law Med . 2016 ; 42 ( 1 ): 7 – 52 . https :// www . ncbi . nlm . nih . gov / pmc / articles / PMC5494184
11 . Patient-Physician Relationships ; American Medical Association Code of Medical Ethics Opinion 1.1.1
https :// www . ama-assn . org / delivering-care / patient-physician-relationships Quote :
“ All physicians have a duty to alleviate suffering . When meeting this obligation includes prescribing controlled substances , Kentucky physicians must know the KBML regulations , follow the regulations , and clearly meet documentation requirements .”
16 LOUISVILLE MEDICINE