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APS Bulletin • Volume 11, Number 2, March/April 2001
President's Message
APS Must Advocate for Policy Improvements
Michael A. Ashburn, MD MPH
Over the past several months, OxyContin has come under siege. Several reports of abuse of OxyContin and other opioids available by prescription have raised concern among policy makers and increased pressure to limit access to these medications.
In an article published in The Cincinnati Enquirer on February 7, 2001, author Walt Schaefer stated that OxyContin has rapidly become a popular drug among addicts. Schaefer wrote that this was due, in part, to a patented bonding agent within OxyContin’s formulation that can actually measure the level of oxycodone in the blood, then releases more or less pain-killer over a 12-hour period.
Law enforcement agents across the United States have reported increased diversion of OxyContin, as this product has become popular among some illicit drug users. OxyContin is often crushed, and then snorted. Alternatively, the drug is dissolved then intravenously injected.
Concerns over diversion and abuse may be decreasing access to the drug for appropriate medical purposes. There have been reports of pharmacies refusing to stock the drug because of fear of theft, and patients have reported that their physicians have become reluctant to continue to prescribe the drug to them. In addition, publicity over the abuse of OxyContin has led to increased concern over the use of opioids for the treatment of chronic pain.
Several years ago the American Pain Society (APS) and American Academy of Pain Medicine (AAPM) prepared and released guidelines on the use of opioids to treat chronic pain. This statement acknowledged that opioids have a role in the treatment of chronic pain in some patients. Concerns over addiction are often not warranted. The guidelines clearly outline a process to be followed when using opioids in this setting.
The APS/AAPM guidelines received widespread distribution and led to vast improvements in public policy about the use of opioids for the treatment of chronic pain. Unfortunately, some of the gains made may now be in jeopardy.
I want to make it clear that opioids alone are rarely effective in the treatment of chronic pain. However, opioids can be effective in some patients as part of an interdisciplinary approach to the diagnosis and treatment of chronic pain. Opioids, similar to other drugs and treatment modalities, must be used responsibly and appropriately to be effective.
There is a risk for diversion when opioids and other controlled substances are prescribed. Some patients will contact physicians to obtain controlled substances for illicit purposes. However, as outlined in the APS/ AAPM guidelines, physicians and other healthcare providers can make reasonable and prudent efforts to guard against diversion while making these substances available to patients that will benefit from them. In addition, they can do this without putting their controlled substance license in danger.
When developing public policy, policy makers must be reminded to develop policy that strikes a balance. We should be able to address concerns over diversion without creating barriers to their appropriate use. However, providers should recognize that opioids are subject to diversion, and society is justified in regulating the administration of opioids to decrease the potential for diversion.
During the debate on this issue, pain professionals will need to watch out for and correct misinformation. Factually incorrect statements such as those that appeared in the aforementioned article must be addressed. We need to participate in the dialogue as advocates for the people we serve.
However, opioid policy is only one issue that we will need to address in the upcoming months. We need to advocate for better support for basic science and clinical research related to pain. In addition, there is a growing need for improved payment policy for pain psychology, physical therapy, and occupational therapy, among others. As a community of pain professionals we need to assist in the development and implementation of meaningful outcome monitoring to learn what really works for our patients and in what setting.
Opioid policy is important but it is only one issue among many that affect pain research and clinical care. APS must continue to work with membership and policy makers to advocate for policy improvements across a wide range of issues.
