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8/11/2004

New Pamphlet Gives Straightforward Answers to Opioid Questions

Cheryl A. Thompson

The Drug Enforcement Administration (DEA) today released an 18-page pamphlet (PDF) to help pharmacists, other health care professionals, and law enforcers better understand the use of controlled substances in pain management and the federal laws and regulations covering that therapy.

Developed by DEA, Last Acts Partnership, and the Pain and Policy Studies Group at the University of Wisconsin, Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel aims to clarify federal policies, not present new ones.

Russell Portenoy, a pain-management physician at Beth Israel Medical Center in New York City and the lead clinician for the writing project, said the pamphlet is the result of trends in the past decade.

"We have witnessed a large increase in the prescription of opioid drugs to treat chronic pain," he said, "which is a change that many pain specialists have welcomed, recognizing that there is an epidemic of chronic pain and that opioids appear to be very much underused and stigmatized."

But coincident with this trend, he explained during a conference call for reporters, the rate of opioid abuse and diversion has increased, although no one has shown scientifically that the greater use of opioids for pain management has fueled the increase in illegal activity.

"We have to recognize that [opioids] are potentially abusable," he said. "They could be diverted to an illicit market, and all the appropriate things have to be done to reduce that risk."

The pamphlet represents the most recent step in efforts by health care professionals and federal law enforcers to achieve a balance so that each group can perform their respective job.

Three years ago, DEA and 21 health organizations issued the following statement: "Preventing drug abuse is an important societal goal, but there is consensus, by law enforcement agencies, health care practitioners, and patient advocates alike, that it should not hinder patients' ability to receive the care they need and deserve."

The group, Portenoy said, decided that it should develop an FAQ to educate the health care, law enforcement, and regulatory communities.

Members of these groups may not know, as the pamphlet explains, that physical dependence is normal during opioid therapy and that tolerance to the analgesic effects of an opioid does not indicate addiction.

"Our goal," said DEA's Patricia M. Good, with the Office of Diversion Control, "is to make sure that we have adequately trained our own personnel." The pamphlet reemphasizes for DEA personnel "that addiction and chemical dependence aren't the same thing," she said.

Portenoy said that pharmacists play a critical role in pain management with opioids and "can be part of the problem or part of the solution."

Those pharmacists who do not know the information presented in the FAQ released today, he said, may end up providing misinformation to patients, increasing their fear, or discouraging them from using appropriate medications.

In Portenoy's experience as a pain management specialist, patients commonly have a negative experience in pharmacies "because the pharmacist is either implying or stating directly that the therapy is inappropriate, that it's dangerous."

"An enlightened pharmacist can be very reassuring and can treat a patient with the kind of respect that the taking of these stigmatized drugs often seems to strip away," he said.

David E. Joranson, director of Wisconsin's Pain and Policy Studies Group, said health care professionals who read the pamphlet must remember that individual states have their own controlled-substance policies and law enforcement organizations. He estimated that 20 states have policies that could be interpreted as mistaking pain management with drug addiction.

The pamphlet underwent review by a 12-member committee that included pharmacists Arthur G. Lipman, of the Pain Management Center at the University of Utah in Salt Lake City, and Michael P. Cinque with excellerx Inc. in Philadelphia.