The Concept of Addiction in Law and Regulatory Policy Related to Pain Management

Aaron M. Gilson, MS, MSSW, PhD

Pain and Policy Studies Group
University of Wisconsin-Madison
Madison, WI

Concerns regarding the potential for opioid misuse and abuse and an inaccurate understanding of the nature of addiction may limit clinicians’ willingness to prescribe these analgesics. Surveys have shown, for instance, that a significant proportion of healthcare practitioners characterize addiction solely by physical dependence or tolerance, and disregard more recent consensus criteria from medical societies. This misperception further manifests in US laws and regulatory policies. To establish an appropriate context for existing policy definitions, Dr. Gilson reviewed reports on historical concepts of addiction, recent changes in the diagnostic criteria for addiction, and current definitions of addiction in federal and state law. Importantly, policy content in certain states does not reflect the current medical and scientific knowledge regarding addiction, including expert conceptualization of a primary, chronic, neurobiologic disease that is characterized by one or more of the following behaviors: impaired control over drug use, compulsive use, continued use despite harm, and craving. These findings have important ramifications and should be addressed to improve the treatment of pain and translate unified addiction nomenclature into clinical practice.

References

Gilson AM. The concept of addiction in law and regulatory policy related to pain management: a critical review. Clin J Pain. 2010;26(1):70-77.
Passik SD, Byers K, Kirsh KL. Empathy and the failure to treat pain. Palliat Support Care. 2007;5:167-172.
Joranson DE, Gilson AM. Pharmacists’ knowledge of and attitudes toward opioid pain medications in relation to federal and state policies.
J Savage SR, Joranson DE, Covington EC, et al. Definitions related to the medical use of opioids: evolution towards universal agreement. J Pain Symptom Manage. 2003;26:655-667.

Would you like to comment? , or in if you are already a member.

Chronic opioid therapy and preventive services in rural primary care: an Oregon rural practice-based research network study.

Buckley DI, Calvert JF, Lapidus JA, et al.
Ann Fam Med. 2010;8(3):237-44.
PURPOSE:...

The impact of enrollment in a specialized interdisciplinary neuropathic pain clinic

Garven A, Brady S, Wood S, Hatfield M, Bestard J, Korngut L, Toth C.
Pain Res Manag. 2011...

Association between urine drug test results and treatment outcome in high-risk chronic pain patients on opioids

Barth KS, Becker WC, Wiedemer NL, Mavandadi S, Oslin DW, Meghani SH, Gallagher RM.
J Addict...

The role of core strengthening for chronic low back pain.

Akuthota V, Standaert CJ, Chimes GP.
PM R. 2011 Jul;3(7):664-70.

A different kind of co-morbidity: Understanding posttraumatic stress disorder and chronic pain

Beck JG, Clapp JD.
Psychol Trauma. 2011 Jun;3(2):101-108.
Many traumatic events leave...