Reform Proposals

Fortunately there are several avenues of potential reform of the problem of opioid pseudoaddiction. Each avenue of reform must strive to rightly-balance the legitimate needs of pain patients to receive adequate analgesia, and the legitimate need for the prevention of diversion and abuse of opioid medications.

This section will address needed education, research, DEA and physician cooperation, diversion and abuse prevention and detection programs, safe harbor, tort liability, intractable pain treatment acts, health organization standards, pharmacies, and state medical boards. Education and research are paramount in combating opiophobia and to educating opioid prescribers on diversion and abuse prevention. The DEA and physicians must cooperate to successfully win the war on drugs while preserving necessary accessible opioid prescribing and dispensing for the pain patient. To preserve physician willingness to prescribe opioids, legislation may give safe harbor to physicians prescribing in good faith, and having an operational diversion and drug abuse prevention and detection program (DAPD). Tort liability for the under-treatment of pain plays a role to further encourage physicians to treat pain adequately whether in the setting of acute, chronic cancer or chronic non-cancer pain. Besides JCAHO standards, institutional policies on adequate pain treatment are also needed. Pharmacist-physician collaboration is necessary to prevent diversion and abuse, and to ensure the availability of opioids in the community for pain patients. The greater role of state medical boards is also required to champion the cause of the pain patient and healthcare provider, and provide support for DAPD programming.