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ACP Concerned DEA Sending Mixed Messages on Pain Control

January 11, 2005

(Washington, DC): The American College of Physicians (ACP) has expressed concern that the Drug Enforcement Administration's (DEA) withdrawal from its Web site of "Frequently Asked Questions" on prescription pain medication and the November 16 interim policy statement, "Dispensing of Controlled Substances for the Treatment of Pain" are causing confusion and will have negative effects on the care of patients and patient-physician relationships

According to the ACP Ethics Manual, physicians have an ethical obligation to provide adequate pain control. Primary care physicians, not only pain specialists, have this duty. ACP feels that fulfillment of this obligation could now be in jeopardy without adequate DEA guidance to health professionals about the prescribing of appropriate pain medications.

"Clinicians need clear guidance on what factors raise questions in the prescribing of pain medications," said Charles K. Francis, MD, FACP, FACC, president, American College of Physicians. "Otherwise, there is a risk that proper prescribing will be discouraged, and physicians will be encouraged to turn away legitimate pain patients for fear of having too many such patients in a practice."

"The abrupt withdrawal of the FAQs in October, without complete and final determinations of policy, sends a message that could have a chilling effect on appropriate pain care," said Dr. Francis. "This leaves open questions about the validity of the content of the majority of the document."

In a letter to the DEA released today, the College expressed reservations about the November Interim Policy Statement and the DEA's explanation of why it withdrew the FAQs. ACP noted that the interim policy statement only partially critiqued the withdrawn Prescription Pain Medications FAQs that had been posted last summer.

"It is extremely important that the medical community and the DEA continue this dialogue, and that final and clear guidance for clinicians and others be made available as soon as possible," said Dr. Francis. "The FAQ document was a very useful tool for providing much needed guidance to clinicians, law enforcement personnel, and others. We would urge the rapid production of a clarified document."

ACP said it shares the administration's goal of balancing appropriate pain management with the administration and enforcement of the laws and regulations governing controlled substances. It applauded previous efforts by the DEA to address the questions and fears of health professionals about prescribing adequate pain medication. However, along with the recent controversy involving side effects of some prescription pain medications, ACP is concerned that physicians can adequately address the pain concerns of their patients, and that patients will feel confident their physicians will do so.

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include more than 116,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.

Jack Pope (202) 261-4556, jpope@acponline.org
Jacquelyn Blaser, (202) 261-4572, jblaser@acponline.org

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