Gilson A M, Joranson D E
Pain & Policy Studies Group, Comprehensive Cancer Center, University of Wisconsin, Madison, WI 53705, USA.
J Pain Symptom Manage. 2001 Mar;21(3):227-37. doi: 10.1016/s0885-3924(00)00263-3.
Physicians report that concern about regulatory investigation negatively influences their prescribing of opioid analgesics. The views of medical regulators about the legality of prescribing controlled substances for pain management were studied in 1991. However, little is known about whether these views have changed in light of increased emphasis on pain management and educational programs for state medical boards. Two studies that examined this issue are described. In Study 1, a 1997 survey of state medical board members was compared to results obtained in 1991 to evaluate differences in knowledge and perceptions about opioid analgesics. Important changes were observed over time, particularly regarding characteristics of "addiction" and the legality of prolonged prescribing of opioids. For Study 2, a longitudinal survey was conducted of medical board members who participated in five workshops about pain management and regulatory policy. Results revealed significant and sustained changes in attitudes about the incidence of iatrogenic addiction when using opioids to treat pain, the analgesic and side-effect properties of opioids, and the perceived legality of prescribing opioids. Recommendations for reducing concerns about regulatory scrutiny are presented, including the need for a more intensive education program, increasing the rate of adoption of new state medical board policies, and improving communication between regulators and clinicians.
医生报告称，对监管调查的担忧会对他们开具阿片类镇痛药的处方产生负面影响。1991年对医学监管者关于开具管制药品用于疼痛管理的合法性观点进行了研究。然而，鉴于对疼痛管理的日益重视以及针对州医学委员会的教育项目，对于这些观点是否发生了变化却知之甚少。本文描述了两项研究该问题的调查。在研究1中，将1997年对州医学委员会成员的调查结果与1991年获得的结果进行比较，以评估对阿片类镇痛药的知识和认知差异。随着时间的推移观察到了重要变化，特别是在“成瘾”的特征以及长期开具阿片类药物的合法性方面。在研究2中，对参加了五个关于疼痛管理和监管政策研讨会的医学委员会成员进行了纵向调查。结果显示，在使用阿片类药物治疗疼痛时医源性成瘾的发生率、阿片类药物的镇痛和副作用特性以及开具阿片类药物的合法性认知方面，态度发生了显著且持续的变化。本文还提出了减少对监管审查担忧的建议，包括需要开展更密集的教育项目、提高新州医学委员会政策的采用率以及改善监管者与临床医生之间的沟通。
