Blair Horner: The Nation Gets Graded On Its Patient Pain Control Polices
Early last month a report graded each of the 50 states’ policies on how well they controlled patients’ pain. The report showed that much progress had been made over the last decade in implementing balanced policies that increase access to effective pain medications and establish a system to mitigate drug abuse. However, much more needs to be done.
The report, Achieving Balance in State Pain Policy: A Progress Report Card, evaluated state policies to improve pain management and patient care. It was prepared by the University of Wisconsin Pain & Policy Studies Group (PPSG). (The report can be found here.)
PPSG researchers evaluated whether state pain policies and regulations enhance or impede pain management. The report assigned each state a grade from ‘A’ to ‘F’ that reflects the quality of its pain policy. The report also evaluated state pain policies in 2000, 2003, 2006, 2007 and 2008 to determine what changes have been made over time. According to the findings, New York State showed a positive change, moving from a C+ to a B in effective pain policies over that time period. New York was one of 9 states to get a B grade. Thirteen states received an A, 18 states received a B+. Georgia, Iowa, Kansas, Maine, Massachusetts, Michigan, Montana, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin all received “A”s as having the most balanced policies in the country related to pain management, including with the appropriate use of pain medications for legitimate medical purposes.
8 states (District of Columbia, Iowa, Kentucky, Massachusetts, New Mexico, New York, Ohio, and Vermont) adopted legislation or regulations mandating continuing education about pain management or palliative care for licensees.
6 states (Indiana, New York, Oklahoma, South Carolina, Tennessee, and West Virginia) adopted laws establishing a responsibility for Opioid Treatment Program staff to either assess for pain or to refer methadone‐maintained patients who have chronic pain for the treatment of their pain.
New York adopted legislation requiring healthcare practitioners to provide patients, who are diagnosed with a terminal illness or condition, with information and counseling about palliative care or end‐of‐life care options, including pain and symptom management. If practitioners are unwilling to provide such information, they must arrange for another clinician to provide the information or refer the patients to another practitioner who is willing to do so.
An estimated 100 million Americans who are affected by chronic diseases, such as cancer, and conditions suffer from pain. Pain is the most common reason Americans access the health care system, and it is the leading contributor to health care costs.
While there are several effective medications and non-drug therapies available for pain treatment, opioid pain medications are often the best treatment for managing serious, persistent pain. But health professionals can be reluctant to prescribe such medications because of the risk of violating laws aimed at preventing trafficking and abuse of controlled substances. Such policies can unduly restrict healthcare decision-making, contradict current medical knowledge, and fail to communicate appropriate messages about pain management and using pain medications.
Too often cancer patients suffer needlessly from pain and other side effects of their treatment. Strong policies can improve access to effective pain medications and preserve patients’ quality of life.
Balanced policies are those that ensure prescription pain medications are available to those who need them, and keep those medications away from the people who misuse them. Laws that specifically address misuse should target the crux of the problem without having a negative impact on cancer patients and others who need these drugs.
The report offers a roadmap for how states can improve their laws. New York – while showing improvement – only received a “B” grade, so more can be done.
New York’s policymakers should review the findings of this comprehensive report. When it comes to patients’ pain management, the state must do all it can to have policies that provide relief – not obstacles.
Blair Horner is the Vice President for Advocacy for the American Cancer Society, Eastern Division. His commentary does not necessarily reflect the views of the American Cancer Society.
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