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During the past decade, the federal government has approved the development and marketing of powerful oral and transdermal narcotic preparations whose unit dose amounts often contain a much greater amount of active ingredient than ever previously allowed in a single dose of such medication. Although these changes have been beneficial in allowing patients suffering from severe chronic pain syndromes to have better access to higher doses of narcotic analgesics, in a minority of cases substance abusing and drug diverting patients have contributed to increases in their own and the public’s morbidity and mortality. Medical and other related regulatory boards have experienced significant difficulties in adapting their regulatory activities to recent increases in the prescribing of high unit dose narcotic preparations. Complicating this problem is the fact that the vast majority of practicing physicians have had little or no formal training in the fields of chronic pain or addiction medicine; and that most physicians completed their training long before the fairly recent approval and marketing of high dosage narcotic medications. These and other factors can contribute to dangerous prescribing practices. The author wishes to assist medical board staff in conducting thorough, consistent and fair investigations of cases involving suspected inappropriate prescribing of chronic pain medications. The attempt has been made to provide a possible approach for adjudicating board members that incorporates accepted modern methods for the compassionate diagnosis, treatment and ongoing monitoring of chronic pain patients that also serves to protect patients, the public, prescribing physicians and the regulatory boards.

Guidelines for Medical Board Investigators and Consultants Dealing with Distressed Pain Medicine Practices