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Pain management education must help prescribers focus less on patient satisfaction, and more on their functional improvement, according to Sherry Green, the CEO of the National Alliance for Model State Drug Laws (NAMSDL).

Current pain management education is largely based on the concern that people in chronic pain are not receiving adequate relief, Green says. “More and more emphasis has been placed on patient satisfaction. With doctor ratings available online, some physicians are concerned that if they don’t give patients what they want, they will drive them away and receive unsatisfactory ratings. That may make them less willing not to give someone the drug they’re asking for.” The pressure to satisfy patients may also come from hospitals, whose own ratings are influenced in part by patients’ satisfaction with doctors, she adds.

Improving prescriber education was one of the topics at the recent meeting convened by NAMSDL for state and local professionals from around the country to identify legislative and policy options for addressing “pill mills” and safeguarding the legitimate practice of pain management.

Participants included doctors, law enforcement officials, medical board representatives and addiction treatment specialists. They crafted a preliminary set of proposals which NAMSDL will distribute in early 2013 to a wide variety of stakeholders for further review and comment. The goal of the multi-step, multi-disciplinary approach is to provide policymakers with practical solutions to preventing prescription drug abuse, addiction and diversion while safeguarding legitimate access to prescription drugs.

Participants at the meeting agreed patient satisfaction may be receiving too much emphasis. “There’s a concern we’ve gone too far down that road,” notes Green.

They also discussed how pill mills have fueled the prescription drug abuse epidemic. “Pill mills do not necessarily refer to a specific location, but rather to a set of practices that is not legitimate medicine,” Green says. “Pill mills’ entire focus is on prescribing drugs, without taking medical histories, performing physical exams or providing followup. There is no individualized care, and the same kinds of pills are given across multiple types of patients.”

Legitimate pain management involves practices diametrically opposed to pill mills, according to Green. “Pain management is more holistic – it looks at other ways of treating pain in addition to pills,” she notes.

Prescription drug monitoring databases as a tool for combating prescription drug abuse will be a big focus on the state level in 2013, she adds. There are many details that states must consider, including whether to require doctors and other prescribers to use the databases.

“Our goal is to see what are the best kinds of policy and regulatory changes that are needed to reduce prescription drug abuse. Once we agree, our stakeholder groups can move forward and make these changes,” she says.


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