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March 20, 2005
Department of Justice
Drug Enforcement Administration
Attention: DEA Federal Register Representative/CCD
2401 Jefferson-Davis Highway
Alexandria , VA 22301
Re: Solicitation of Comments on Dispensing of
Controlled Substances for the Treatment of Pain
Docket No. DEA-261
Dear Sir or Madam:
On behalf of the more than 55,000 clinically practicing physician assistants (PAs) who are represented by the American Academy of Physician Assistants (AAPA), I am pleased to submit brief comments on the dispensing of controlled substances for the treatment of pain.
Physician assistants are graduates of accredited PA educational programs who are authorized by the state to practice medicine with the supervision of licensed physicians. Physicians may delegate to PAs those medical duties that are within the physician's scope of practice and the PA's training and experience, and that coincide with those duties that are allowed by state law. Forty-eight states, the District of Columbia , and Guam authorize physicians to delegate prescriptive privileges to the PAs they supervise.
PAs deliver a broad range of medical and surgical services to diverse populations in rural and urban settings. In some rural communities, a PA is the only medical provider. Based on its annual collection of data on the profession, the AAPA estimates that nearly 207 million patient visits were made to PAs and over 250 million prescriptions were written by PAs in 2004.
AAPA policy endorses proper treatment of pain through appropriate means, including the use of opioids. AAPA also encourages continuing education for PAs on the appropriate management of pain and use of medications, while encouraging PAs to identify patients who may be developing addictions to pain medication.
AAPA appreciates the Drug Enforcement Administration's (DEA's) responsibility to enforce the law regarding diversion and abuse of controlled substances. However, the AAPA believes that
the DEA's law enforcement efforts to control diversion and abuse ought not restrict patients' access to medically appropriate pain relief. The Academy also believes that DEA's law enforcement efforts should not supercede health care professionals' clinical judgment regarding pain management.
Good patient care requires health care professionals to utilize every tool available, including the use of opioids and other controlled substances, to manage acute and chronic pain. Indeed, according to the Federation of State Medical Boards' Model Policy for the Use of Controlled Substances for the Treatment of Pain, "inappropriate treatment, including the undertreatment of pain, is a departure from an acceptable standard of practice." The responsibility to treat pain, coupled with a fear of overzealous investigation and sanction by the DEA, place health care professionals in a difficult position -- to undertreat pain and risk disciplinary action by the regulatory body that governs the practice of medicine or to provide medically appropriate, humane treatment and risk disciplinary action that is generated by the DEA.
Unfortunately, the publication and retraction of the DEA document, "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel," exacerbated an already existing uncertainty among health care professionals on how to treat patients' pain and avoid legal action that may be generated by the DEA. As each state has existing mechanisms to regulate the practice of medicine, we strongly encourage the DEA to clarify that its mission, role, and expertise do not include regulating the practice of medicine.
Thank you for the opportunity to submit comments on the dispensing of controlled substances for the treatment of pain. Should you have any further questions or require additional information, regarding the PA profession or prescribing practices, the AAPA, or the AAPA's comments, please do not hesitate to contact Sandy Harding, AAPA Director of Federal Affairs, at (703) 836-2272, extension 3205.
Sincerely,
Stephen C. Crane, PhD, MPH
Executive Vice President & CEO
Last Revised: 3/21/05
