1. Texas State Board of Medical Examiners Bruce A. Levy, M.D., J.D.

2. Proper Prescribing Definitions Non-therapeutic prescribing - A medical use or purpose that is not legitimate Prescribing pharmaceuticals or practicing consistent with the public health and welfare - Prescribing pharmaceuticals and practicing medicine for a legitimate medical purpose in the usual course of professional practice.

3. Intractable pain A pain state in which the cause of the pain cannot be removed or otherwise treated and which in the generally accepted course of medical practice no relief or cure of the cause of the pain is possible or none has been found after reasonable efforts.

4. Proper Prescribing for Pain Guidelines for the proper prescribing for pain according to Board rule 170.3. Documented medical history Physical examination Recognized medical indication Written treatment plan Discuss risks and benefits of medication with patient

5. Proper Prescribing for Pain Guidelines for the proper prescribing for pain according to Board rule 170.3 (Cont’d) Periodic review at reasonable intervals Complete and accurate records Closer monitoring of patients with history of substance abuse

6. Prescribing Practices Warranting Board Scrutiny Issuing prescriptions for large amounts of controlled substances and/or in excess of prescribed dosage Failing to keep accurate records Failing to evaluate/monitor patients Prescribing to drug-dependent persons without adequate consultation/evaluation and monitoring

7. Controlled Substance Violations (Prescribing Violations)

8. Actions by Percentage of Totals

9. Challenge to State Medical Boards To protect the medical uses of controlled substances and simultaneously prevent drug diversion and abuse Ensure public access to effective pain control

10. Status of State Pain Policies/Laws

11. Pain Management and State Regulatory Policy A project funded by the Robert Wood Johnson Foundation Purpose –Develop model guidelines for use by state medical boards and other healthcare regulatory agencies to promote the appropriate prescribing of controlled substances (opioids) in the management of chronic malignant and non-malignant pain

12. Project Objectives Establish consistent standards for managing chronic pain based on current research data Promote a non-legislative approach to address the use of controlled substances in the management of chronic pain

13. Model Guidelines for the Use of Controlled Substances for the Treatment of Pain FSMB House of Delegates May 1998

14. Grant extended through 3/00 Workshops for Board Investigators (4) Developed position paper Communicated with all member boards –Position –Model Guidelines Targeted states w/out policy –Direct communication (telephone) with FSMB Legislative Staff

15. FSMB Pain Management Initiative: Phase 2 Improve the quality of patient care through appropriate and effective pain control –Build relationships to increase physician knowledge of current standards for appropriate pain treatment –Assist and inform the licensee population of state-specific expectations regarding physician responsibilities in treating pain