Development of the Model Policy for the Use of Controlled Substances for the Treatment of Pain

The Federation of State Medical Boards' (FSMB) Model Policy for the Use of Controlled Substances for the Treatment of Pain is a revision of a set of guidelines developed by the FSMB in 1998. The original project was initiated in 1997 by the FSMB, through it's Foundation, to assist state medical boards and other health care regulatory boards in promoting the appropriate use of controlled substances in the management of chronic cancer and non-cancer pain. The project was funded by the Robert Wood Johnson Foundation and developed in collaboration with the American Society of Law, Medicine, and Ethics, the American Pain Society, the American Academy of Pain Medicine, the University of Wisconsin Pain and Policies Studies Group (PPSG), and state medical boards.

This initiative resulted in development of the FSMB's policy, Model Policy for the Use of Controlled Substances for the Treatment of Pain. More than 300,000 copies of the original guidelines have been distributed to state medical boards, medical professional organizations, other health care regulatory boards, patient advocacy groups, pharmaceutical companies, and state and federal regulatory agencies since its adoption and 24 state medical boards have adopted all or part of the guidelines for their own policies. In addition, the guidelines have been endorsed by the American Academy of Pain Medicine, the Drug Enforcement Administration, the American Pain Society, and the National Association of State Controlled Substances Agencies.

Despite the wide distribution and adoption of the 1998 document, there is a significant body of evidence that suggests widespread acute and chronic pain continue to persist in the United States The most common barriers are lack of understanding in the medical community about the treatment of pain and fear among physicians that they will be investigated, or even arrested, for prescribing controlled substances for pain.

A resolution to the FSMB's House of Delegates in April 2003, called for the FSMB to review the 1998 guidelines and, in May 2004, the delegates adopted the Model Policy for the Use of Controlled Substances for the Treatment of Pain.

The new policy:

• recognizes the inadequate management of pain and barriers to appropriate treatment;
• emphasizes the dual obligation of government to develop a system that prevents abuse, trafficking and diversion of controlled substances while ensuring their availability for legitimate medical purposes;
• revises definitions of addiction, chronic pain and physical dependence to reflect current consensus and expertise in the medical community; and
• updates criteria for evaluating the appropriate management of pain