Pain Management

Over the past ten years, there has been a growing trend for states to adopt policies which adopt policies which address the prescribing of opioid analgesics for chronic pain.  In 1989, for example, Texas passed the first intractable pain treatment act which defines intactable pain and grants immunity from disciplinary action by the medical board to physicians when they prescribe opioids for intractable pain.  California followed suit in 1990 and Florida in 1994.  Since 1989, nineteen states have passed intractable pain laws that permit the prescribing f opioid medication for chronic pain patients. For more information about a specific state policy or guidelines, please visit our Pain Policy Map.

Before examining individual state policies regarding the prescribing of controlled substances for the treatment of pain, it is necessary to introduce federal provisions. These are explained below.

Congress states in the legislative findings section of the CSA that "many of the drugs included within this title have a useful and legitimate medical purpose and are necessary to maintain the health and general welfare of the American people." Moreover, the regulation implementing CSA states that "for a controlled substance to be effective [a prescription] must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice."

The Code of Federal Regulations (CFR) requires prescriptions by a physician for a controlled substance to be issued for "a legitimate medical purpose in the usual course of professional practice." Harrison Narcotic Act 26 C.F.R. §§ 151.90, 151.67 (1939). The Department of Justice uses the Harrison Narcotic Act of 1914 in implementing and interpreting the Controlled Substances Act (CSA).

As mentioned earlier, there has been increasing recognition on the part of health care professionals and policymakers that the management of pain, including chronic noncaner pain, is woefully inadequate. In response, several states have adopted new policies to better characterize the conditions under which opioids could be prescribed for the management of pain.  A number of laws have been adopted by different states concerning pain management. (Law is a broad term that refers to rules of conduct with binding legal force). The following states have passed intractable pain treatment acts that permit the prescribing of opioid medication for chronic pain patients:

• California
• Colorado
• Florida
• Michigan
• Minnesota
• Missouri
• Nevada
• North Dakota
• Ohio
• Oregon
• Rode Island
• Texas
• Virginia
• Washington
• Wisconsin

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