State laws are similar to federal laws in that they both allow controlled substances to be prescribed for specific medical purposes. States, however, are allowed to add additional restrictions to federal laws, and in the case of opioid treatment for intractable pain, most states do not recognize the legitimacy of opioids for intractable pain.¹

Several factors contribute to states’ lack of recognition of opioid legitimacy for intractable pain, overregulation of opioid treatment for intractable pain, the prosecution of legitimate physicians, and the undertreatment of intractable pain patients. These include:¹

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

State medical boards (consisting mostly of physicians) and the DEA work together to regulate opioid prescribing; however, their lack of knowledge of the pharmacological effects of opioids for intractable pain, their fear of addiction, and their fight against drugs as a whole in our society has compelled them to overregulate drugs that adequately treat intractable pain. In order for states to allow physicians to provide adequate amounts of opioids to intractable pain patients, state medical boards and the DEA need to become better educated about the advancements being made in intractable pain management.

Some state medical boards have reached a turning point in their knowledge of adequate intractable pain treatment and have made steps toward ensuring safe opioid treatment. To create an ideal atmosphere that supports adequate opioid treatment, states should strive to:

• Define addiction terminology more accurately so that healthcare providers do not falsely associate addiction with opioid pain treatment^1,11
• Remove dosage limitations from the laws so that pain patients receive adequate amounts of opioids to relieve their pain^1,2,12
• Eliminate multiple copy prescription programs so that legitimate physicians do not compromise their patients’ pain treatment for fear of regulatory investigation^3,14-16
• Support electronic monitoring systems but discourage adding more schedules to state medical board regulations so that further stigmas toward opioid treatment do not develop
• Create an educational effort to teach themselves on the legality of opioids for intractable pain so that they do not overregulate and therefore restrict patients from receiving the correct amount of pain medication¹¹