North American Region

The Center is actively involved in policy and communications activities that are relevant to the Center's terms of reference in the USA. These activities are briefly summarized:

Regional Meeting: American Association for Cancer Education:

In 1998, the Center participated in the annual meeting of the American Association for Cancer Education (Portland, Oregon). Dr. Colleau presented a lecture on "A global network for cancer pain education." The objective was to explain how the Center supports the WHO's Program on Cancer Control by providing a global communications mechanism for physicians, nurses, pharmacists, researchers, government officials and other health professionals about cancer pain relief and palliative care. Strategies to broaden the global communication network were discussed in order to keep pain control an international priority in cancer education, as recommended by WHO.

Use and Abuse of Opioid Analgesics:

In 1998, the Center began an analysis of trends in the medical use and abuse of opioid analgesics used to treat severe pain, which was then published in the Journal of the American Medical Association.⁴² The study used two national databases to measure both the medical consumption and the abuse of opioid analgesics. Results demonstrated that while there was a substantial increase in the medical use of opioid analgesics between 1990 and 1996, their abuse over this same time period has remained low and stable.

The Center uses opioid consumption data to study consumption trends for the entire US and for individual states, similar to our use of such data to monitor consumption trends in the world and in individual countries. These data contribute to the Center's ability to educate health care professionals and regulators about drug availability and pain relief issues.

Analysis of State Pain Policies:

In 1999, the Center conducted an analysis of laws and regulations in a sample of 17 states to identify provisions that may enhance or impede pain management. The analysis is based on a Central Principle of "Balance," which states that government policies to prevent misuse of controlled substances should not interfere with their use for the relief of pain. From the Central Principle, the authors derived a set of criteria against which the policies were examined. Examples of how states may improve their policy and regulatory climate are provided. The intended audience for the document is individuals or groups working to improve end of life care, associations of professionals, cancer pain and palliative care initiatives, state professional licensing boards and state legislatures. The resulting document, Achieving balance in state pain policy: a guide to evaluation,⁴ was published in July 1999 and can be found on the Center's website. The publication already has been used as a tool for policy change. The Center is completing its analyses on the remaining US states and territories, as well as federal policy, and a final report will be published in 2000.

Collaboration with Regulatory Agencies: Prescription Monitoring Programs:

In 1998, the Center initiated a collaborative project with the US Drug Enforcement Administration, the Alliance of States with Prescription Monitoring Programs, and the Regulatory Affairs Committee of the American Pain Society to exchange perspectives on the relation of government prescription monitoring programs (PMPs) and the prescribing of opioid analgesics for pain management. A working group met in Madison, Wisconsin from July 20-21, and again in Charleston, South Carolina on October 29. The objective was to achieve agreement on the importance of adequate pain management and the need to achieve a balance between drug regulation and the medical use of opioids for pain management. A jointly-authored article is in preparation that outlines the need to disseminate accurate information about PMPs, how they work, what they are intended to achieve and that they are not intended to interfere in medical practice. The project is intended to increase the communication between pain management and regulatory bodies. Since 1998, there have been numerous occasions where the pain management and regulatory communities have invited each other to speak at their conferences.

Federation of State Medical Boards of the US:

The Center has collaborated on three projects with the national association of all state agencies that license and discipline physicians, the Federation of State Medical Boards of the United States (FSMB).

Survey of Medical Board Members:
We surveyed state medical board members in 1997 and compared these results to responses obtained from the same survey we conducted in 1991. There were positive and statistically significant differences over time in respondents' attitudes about the legality of prescribing opioid analgesics for various patient scenarios. Medical board members in 1997 were more accepting of the legality of extended opioid prescribing for patients with chronic cancer and non-cancer pain than they were in 1991. A manuscript has been accepted for publication in the Journal of the American Medical Association.⁴³

Medical Board Workshops:
We sponsored five regional workshops for state medical board members with the FSMB in 1998, bringing the total to 11. A pre-/post-test survey as well as a six-month follow-up survey was completed by each workshop participant. Statistically significant improvements in knowledge and attitudes were observed for items related to the pharmacology of opioids, their addiction potential, correct characteristics of addiction, and the legality of the prolonged use of opioids for pain management. The results of the survey suggested that these workshops were effective in promoting lasting changes in knowledge and attitudes of state medical board members regarding both clinical and policy issues. An article has been accepted for publication in the Journal of Pain and Symptom Management.⁴⁴

Development of Model Guidelines:
In early 1998, the Center conducted a content evaluation of pain management policies that had been adopted by state medical boards. The Center used the results of this evaluation to assist the FSMB to draft Model guidelines for the use of controlled substances for the treatment of pain ⁴⁵ which the FSMB adopted in May 1998 and distributed to each state medical board. The purpose of the Model guidelines is to promote consistency in state medical policy, to encourage better pain management, and to dispel physicians' fear of discipline by state regulatory agencies. A manuscript which describes a decade of change in state medical board policy has been submitted for publication in the Journal of the American Medical Association.⁴³ Representatives of the FSMB have presented the information at national pain conferences and have encouraged the adoption of the Model Guidelines by state medical boards.

Latin American Region

European Region

Asian Region

African Region

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