Gilson Aaron M, Maurer Martha A, Joranson David E
Pain and Policy Studies Group, Comprehensive Cancer Center, University of Wisconsin, Madison, Wisconsin 53711-1068, USA.
J Pain. 2007 Sep;8(9):682-91. doi: 10.1016/j.jpain.2007.05.012. Epub 2007 Jul 12.
Three national surveys were conducted in 1991, 1997, and 2004 to evaluate state medical board members' knowledge and attitudes about prescribing opioid analgesics for pain management. Topics addressed include perceived legality of prolonged opioid prescribing, characteristics of addiction, prevalence of medication abuse and diversion, and perceived importance and influence of medical board policy. Questions were added in 2004 to determine board members' views about law enforcement involvement in physician investigations and prosecutions. This study assesses medical regulators' current beliefs and compares the 2004 responses with previous responses to determine how knowledge and attitudes about prescribing opioids have changed in recent years. Survey results show that board members have a greater understanding of pain management issues, particularly regarding characteristics of addiction and the legality of prolonged opioid prescribing for chronic noncancer pain. During the last 15 years, there has been substantial regulatory policy development, with medical boards adopting regulations, guidelines, or policy statements to provide guidance to licensees about using opioids to treat pain. However, many board members believe that federal and state law enforcement agencies have increased criminal investigations and prosecutions of physicians. We discuss appropriate regulatory and law enforcement responses to opioid prescribing violations, and suggest crucial next steps.
The authors examine the evolution of state medical board members' knowledge and attitudes about prescribing opioid analgesics to treat chronic pain, demonstrate that medical regulators believe that there have been increased criminal investigations and prosecutions of physicians for their prescribing practices, and suggest ways to avoid unwarranted criminal prosecutions.
1991年、1997年和2004年进行了三项全国性调查，以评估州医学委员会成员在使用阿片类镇痛药进行疼痛管理方面的知识和态度。涉及的主题包括长期开具阿片类药物的合法性认知、成瘾特征、药物滥用和转移的发生率，以及医学委员会政策的重要性和影响力认知。2004年增加了一些问题，以确定委员会成员对执法部门参与医师调查和起诉的看法。本研究评估了医疗监管者当前的观念，并将2004年的回复与之前的回复进行比较，以确定近年来在开具阿片类药物方面的知识和态度有何变化。调查结果显示，委员会成员对疼痛管理问题有了更深入的理解，尤其是在成瘾特征以及为慢性非癌性疼痛长期开具阿片类药物的合法性方面。在过去15年中，监管政策有了实质性发展，医学委员会采用了法规、指南或政策声明，为持照者使用阿片类药物治疗疼痛提供指导。然而，许多委员会成员认为，联邦和州执法机构增加了对医师的刑事调查和起诉。我们讨论了对阿片类药物处方违规行为的适当监管和执法应对措施，并提出了关键的下一步措施。
作者研究了州医学委员会成员在开具阿片类镇痛药治疗慢性疼痛方面的知识和态度的演变，表明医疗监管者认为因医师的处方行为而对其进行的刑事调查和起诉有所增加，并提出了避免不必要刑事起诉的方法。
