Because opioid pseudoaddiction stems from inadequate opioid use for pain control, any regulation affecting opioid prescription may impact the incidence of opioid pseudoaddiction. The federal regulation at issue here is the CSA, which controls controlled substances prescription by United States physicians. Although states do not have exclusive jurisdiction to regulate healthcare professionals, lack of commitment to federalism in controlling medical practice erodes states' rights. States should have the right to regulate the prescribing and dispensing of controlled substances within their state. Several benefits to federalism are as follows: (1) states can balance actions of a centralized government; (2) state's rights improve accountability; (3) state level decision-making gives citizens more opportunity for participation; (4) state level solutions are better tailored to local needs; (5) state level decision-making allows for experimentation and comparisons between various state programs; and (6) federalism gives citizens choices among various alternatives by choosing their state of residence. Congress has repeatedly made known its intention that the federal government cannot interfere with the rights of states to regulate the practice of medicine. State statutory definitions of the practice of medicine include prescribing medications. The federal Medicare statute states, Nothing in this title [42 USCS 1395 et seq.] shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided. More recent federal enactments such as the Drug Addiction Treatment Act of 2000 have similar provisions that have become essentially boilerplate. The CSA, however, implicates a sizeable federal role in physician prescribing supervision, by determining which medications are controlled substances, and when and how these controlled substances are prescribed. Although there is no Constitutional prohibition against state and federal governments sharing in the regulation of medical practice, the balance of power between the states and the federal government is currently leaning too far to the side of the federal government.
The usurping of states' rights in healthcare regulation alienates physicians who are organized by state medical boards. The DEA, and not the states, currently decides what constitutes legitimate medical practice in opioid prescribing. The lack of connection between how physicians are organized and how they are regulated in the area of opioid prescribing causes antagonism between the medical profession and the DEA. Such antagonism deters the cooperation necessary for a balance to be struck between the war on drugs and the war on pain.