The Texas State Board of Pharmacy
Effective Date:  August 29, 2001
Texas State Board of Pharmacy Position Statement on the Treatment of Pain

The Texas State Board of Pharmacy has recently adopted the following “Position Statement on the Treatment of Pain.” The Board hopes that this policy will clarify the Board’s position.

  The Texas State Board of Pharmacy recognizes that quality care dictates that the people of the State of Texas have access to appropriate and effective pain relief.  The appropriate application of up-to-date knowledge and treatment modalities can serve to improve the quality of life for those patients who suffer from pain as well as reduce the morbidity and costs associated with untreated or inappropriately treated pain.  The Board encourages pharmacists to view effective pain management as a part of quality care for all patients with pain, acute or chronic, and it is especially important for patients who experience pain as a result of terminal illness.  All pharmacists should become knowledgeable about effective methods of pain treatment as well as statutory requirements for dispensing controlled substances. 

Inadequate pain control may result from physicians’ and pharmacists’ lack of knowledge about pain management or an inadequate understanding of addiction.  The Board recognizes that controlled substances, including opioid analgesics, may be essential in the treatment of acute pain due to trauma or surgery and chronic pain, whether due to cancer or non-cancer origins.

The Board also recognizes that controlled substances are subject to abuse by individuals who seek them for mood altering and other psychological effects rather than their legitimate medical uses.  When dispensing controlled substances, the pharmacist should be diligent in preventing them from being diverted from legitimate to illegitimate use.  Tolerance and physical dependence are normal consequences of sustained use of these drugs and are not synonymous with psychological dependency (addiction).  Psychological dependency is characterized by the compulsion to take the drug despite its harmful and destructive effect on the individual.

Pharmacists should not fear disciplinary action from the Board for dispensing controlled substances, including opioid analgesics, for a legitimate medical purpose and in the usual course of professional practice.  The Board will consider dispensing controlled substances for pain to be for a legitimate medical purpose if based on accepted scientific knowledge of the treatment of pain and sound clinical grounds.  All such dispensing must be based on clear documentation of the patient’s medical condition and pertinent discussions with the prescribing physician.