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7 Articles in Volume 5, Issue #5
Effective Non-Drug Treatment of Depression
First Line Treatment of Musculoskeletal and Neuropathic Pain
Pain Drug Use Policy
Targeted Peripheral Analgesics in Chronic Pain Syndromes
Therapeutic Drug Monitoring
Tiredness and Chronic Pain Management
TMD/Facial Pain and Forward Head Posture

Pain Drug Use Policy

While state boards of medical examiners are responsible for adopting and enforcing a policy for the use of controlled substances for the treatment of pain, each state board must do so within the limits of federal-controlled substance laws and regulations.
Page 4 of 6

The Myth of the “Chilling Effect”2 Doctors Operating Within Bounds of Accepted Medical Practice Have Nothing to Fear From DEA

Drug Enforcement Administration (DEA) statistics show that the vast majority of practitioners registered with DEA comply with the requirements of the Controlled Substances Act (CSA) and prescribe controlled substances in a responsible manner in treating their patients’ medical needs.

One of the the missions of the Drug Enforcement Administration (DEA), Diversion Control Program (DCP), is to prevent, detect and investigate the diversion of legitimately manufactured controlled substances. The Controlled Substances Act (CSA) requires doctors to become registered with DEA in order to prescribe, dispense or administer controlled drugs to their patients for legitimate medical reasons.

The DEA may initiate an investigation of a practitioner upon receipt of information of an alleged violation of the provisions of the CSA and may pursue sanctions against the practitioner based upon the facts determined from that investigation.

Since FY 1999 the DEA registrant population has continually increased reaching almost 1 million doctors (as of June 30, 2003). During this same time, DEA has pursued sanctions on less than one tenth of one percent of the registered doctors. The pie charts pictured put this in graphic perspective.

Table 1. Patient Characteristics Prior to Prolotherapy
  Number Percent
Total number of doctor registrants 963,385 100.0%
Investigations of doctors initiated FY 2003* 557 0.06%
Actions taken against doctors FY 2003* 441 0.05%
Arrests of doctors in FY 2003* 34 0.01%

Actions taken by DEA include: letters of admonition, informal hearings, civil penalties, voluntary surrenders of registration for cause, revocations of registrations, and arrests.

DEA Reversal on Collaborative FAQ

In August, 2004, The Drug Enforcement Administration (DEA) posted a 48-page FAQ titled ‘Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel’ on its website. This document had been jointly written with the University of Wisconsin Pain and Policy Studies Group and the Last Acts Partnership and had gone thru numerous iterations to satisfy DEA concerns over a period of two years. Once posted, DEA administrator Karen Tandy declared: The medical and law enforcement communities continue to work together to carefully balance the needs of legitimate patients for pain medications against the equally compelling need to protect the public from the risk of addiction and even possible death from these medications. ... The DEA is committed to assisting the overwhelming majority of health care providers who successfully strike that balance every day, as well as the law enforcement officers investigating diversion and abuse of pain medications.”3

However, this document was withdrawn within two months of it’s release without notification of the original collaborators with the following message posted on the website:

The document contained misstatements and has therefore been removed from the DEA Web site. DEA wishes to emphasize that the document was not approved as an official statement of the agency and did not and does not have the force and effect of law.

DEA recognizes that the proper use of controlled substances in the treatment of pain remains an extremely important issue. Accordingly, DEA intends to address this matter in the future.4

Finally, in the November 2004 issue of the Federal Register (Vol. 69, No. 220), the DEA addressed the “misstatements” that had caused the demise of the original document.5 Below is the verbatim entry from the November 2004 Federal Register:

Drug Enforcement Administration

[Docket No. DEA-258S]

Dispensing of Controlled Substances for the Treatment of Pain

Agency: Drug Enforcement Administration (DEA), Department of Justice.

Action: Interim policy statement.

Summary: In August 2004, DEA published on its Office of Diversion Control Web site a document entitled: ‘’Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel’’ (August 2004 FAQ). The August 2004 FAQ was not published in the Federal Register and was not an official statement of the agency. DEA subsequently withdrew the document because it contained misstatements. This interim policy statement explains how some of the statements in the August 2004 FAQ were erroneous. In addition, this interim statement explains how DEA plans to address in a future Federal Register document the issue of dispensing controlled substances for the treatment of pain.

For further information contact: William J. Walker, Deputy Assistant Administrator, Office of Diversion Control, Drug Enforcement Administration, Washington, DC 20537; telephone, (202) 307-7165.

Supplementary Information: In August 2004, DEA published on its Office of Diversion Control Web site a document entitled: ‘’Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel’’ (August 2004 FAQ). For the reasons provided below, the August 2004 FAQ was not an official statement of the agency and DEA subsequently withdrew the document because it contained misstatements. Nonetheless, the subject matter—dispensing controlled substances for the treatment of pain—is extremely important to the public health and welfare. As the agency primarily responsible for enforcement and administration of the federal laws and regulations governing controlled substances, DEA believes that further discussion of the subject is warranted for two fundamental reasons. First, the abuse of pharmaceutical narcotics and other prescription controlled substances is increasing in the United States. According to the latest National Survey on Drug Use and Health, which is published by the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), the number of Americans aged 12 or older who have engaged in illicit (nonmedical) use of pain relievers during their lifetime has risen to more than 31 million.1 A portion of this type of drug abuse is directly facilitated by a small number of physicians who dispense controlled substances for other than legitimate medical purposes and then fraudulently claim that the drugs were dispensed for the treatment of pain.

Last updated on: December 20, 2011
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