State and Federal Guidelines on Prescribing Controlled Substances

Howard A. Heit, MD, FACP, FASAM

Georgetown University School of Medicine
Washington, DC

By following state and federal guidelines on prescribing controlled substances, physicians can treat chronic pain in patients who have no history of addiction, those who are recovering from addiction, and even patients with active addiction. For each patient, robust documentation of the pain diagnosis, therapeutic plan, and treatment outcomes is paramount. Moreover, a clear exit strategy should be included in any pharmacologic treatment trial. When faced with aberrant drug taking, it is essential to separate the motive from the problematic behaviors before arriving at a differential diagnosis. Here, Dr. Heit discusses prescribing pain medications based on government requirements, while ensuring the best possible treatment for patients with chronic pain and comorbid addiction. Topics include corrections of prescriptions by pharmacists, emergency prescriptions, and sequential prescriptions.

References

1. Gourlay DL, Heit HA. Pain and addiction: managing risk through comprehensive care. J Addict Dis. 2008;27(3):23-30.
2. Savage SR, Kirsh KL, Passik SD. Challenges in using opioids to treat pain in persons with substance use disorders. Addict Sci Clin Pract. 2008;4(2):4-25.
3. Gilson AM. State medical board members' attitudes about the legality of chronic prescribing to patients with noncancer pain: the influence of knowledge and beliefs about pain management, addiction, and opioid prescribing. J Pain Symptom Manage. 2010;40(4):599-612.

, MD 31 July, 2011

Very informative.

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