Three layers of governmental authority prepare laws and guidelines that supervise availability of prescription drugs:

1. International treaties
2. Federal laws and regulations
3. State laws and regulations

Regarding opioid use for intractable pain, international treaties and federal laws recognize the necessity of balance between providing adequate amounts of opioids for intractable pain and controlling drug abuse.

State laws, on the other hand, tend to place additional restrictions upon opioids to control drug diversion (using prescription drugs for recreational use); however, the restrictions usually interfere with intractable pain patients’ receiving adequate amounts of opioids for pain relief.^1,2 The factors that contribute to states' interfering with adequate opioid treatment are:

1. ambiguously defined terms for addiction
2. opioid dosage unit limitations
3. multiple copy prescription programs
4. electronic monitoring systems
5. falsely perceived illegality of opioids for intractable pain

Turning point for patients and model guidelines