US policies relevant to the prescribing of opioid analgesics for the treatment of pain in patients with addictive disease

Undertreatment of pain is likely to occur among patients with active addiction or those who have a history of addiction. One of the factors that can contribute to the inadequate treatment of pain in this patient population is the presence of laws and regulations that, when implemented, could impede effective pain management. This article describes the current status of federal and state policy governing the medical use of opioid analgesics for pain management with patients who have an addictive disease in the U.S. Three types of policy barriers are discussed: (1) those that can affect pain management in any patient, (2) those that can lead to patients in pain being classified as "addicts," and (3) those that relate specifically to patients with a high risk of addiction. Also presented are recent policy initiatives that can improve the use of controlled substances to treat pain and, thus, ultimately enhance pain relief for patients with an addictive disease.