Objective
To remove excessive restrictions and barriers that prevent chronic pain patients from accessing necessary medication, end the punitive “war on opioids,” and shift focus to compassionate, patient-centered care that allows pain patients to live with dignity and reduced suffering.
Background
The opioid crisis has led to sweeping policies aimed at curbing misuse and addiction. However, these one-size-fits-all policies disproportionately harm legitimate pain patients who rely on opioids to manage severe or chronic pain. Importantly, people are not dying from prescribed opioids used under medical supervision; they are dying from dangerous street drugs, such as illicit fentanyl, which many turn to out of desperation when they cannot obtain their regular pain medication. These blanket restrictions, enforced by regulatory pressures and stigma, limit doctors’ willingness to prescribe essential medications and force patients into potentially deadly alternatives.
Doctors increasingly face scrutiny and legal risks when prescribing opioids, with regulatory bodies threatening fines, license suspensions, and even criminal charges. This has created a climate of fear among healthcare providers, many of whom avoid prescribing pain medication altogether to protect their careers. As a result, countless patients with legitimate pain needs go untreated, suffering unnecessarily because doctors are afraid to provide appropriate care. With fentanyl and other illicit drugs causing the majority of opioid-related deaths, it’s clear that the war on opioids should focus on illicit substances, not the regulated medications that chronic pain patients need to maintain quality of life.
Policy Recommendations
- Eliminate Unnecessary Doctor Visits and Evaluations
- Context: Currently, in most states, chronic pain patients must visit their pain management doctor every two months for reevaluation to receive a prescription, as refills are not allowed. This requirement places undue burdens on patients, including extra costs, time, and stress—especially for those with limited mobility or resources. For Schedule II medications like Percocet, Dilaudid, and OxyContin, federal law mandates that each prescription be issued anew, preventing automatic refills.
- Proposal: For patients with established chronic conditions and no history of misuse, permit new prescriptions to be written each month for three to six months without requiring an in-person office visit every time. Providers could conduct follow-up evaluations via telemedicine or periodic in-person visits as medically appropriate. This approach reduces the need for frequent in-person evaluations while complying with existing federal laws. It eases the burden on chronic pain patients by minimizing unnecessary doctor visits, thereby reducing costs and stress, especially for those with limited mobility or resources.
- Remove Mandatory and Invasive Questionnaires and Contracts
- Context: Pain patients are often required to complete detailed questionnaires and sign contracts to prove they are “worthy” of receiving their medication, often agreeing not to use alternative relief options like THC or kratom. These requirements are demeaning and restrict patients’ rights to explore complementary treatments. Additionally, they’re asked about recent ER visits, which can lead to patients being labeled as drug-seeking, even for genuine emergencies. As a result, many chronic pain patients now avoid ER visits for fear they’ll be unfairly labeled as addicts or have their medications withheld—an outcome that can be life-threatening.
- Proposal: Eliminate these invasive questionnaires and restrictive contracts for patients with a documented need for long-term pain management. Allow patients the autonomy to explore complementary therapies as part of their pain relief plan, particularly those that are legally available and proven to provide relief. Remove questions about ER visits that contribute to stigma and discourage patients from seeking necessary emergency care.
- Eliminate Excessive Drug Testing Requirements
- Context: Chronic pain patients must undergo frequent drug tests to prove they are not misusing their prescriptions. These tests, which treat patients as though they are guilty until proven innocent, add stress and financial burden to patients with no history of misuse. These drug tests often yield inaccurate results, leading to patients losing access to their medication or even being dismissed from care.
- Proposal: Eliminate or reduce mandatory drug testing for stable, long-term patients with no history of abuse. For patients with a documented history of compliance, these invasive tests should be performed only if misuse is reasonably suspected, rather than as a blanket requirement.
- Protect Doctors from Unjust Legal Repercussions
- Context: The fear of legal and professional consequences has led many doctors to avoid prescribing pain medication altogether, leaving legitimate pain patients untreated. The current regulatory environment creates a climate of fear, where doctors prioritize avoiding penalties over treating pain.
- Proposal: Establish clear, protective guidelines for healthcare providers treating chronic pain patients, ensuring they can prescribe medication based on medical need without fear of losing their licenses or facing legal action. Protect doctors who act in good faith from unwarranted scrutiny, penalties, and criminal charges, allowing them to treat patients without risking their careers.
- Permit Freedom to Change Providers and Pharmacies as Needed
- Context: Under current policies, once a patient receives a prescription from a provider, they cannot seek second opinions from other doctors or fill prescriptions at multiple pharmacies without being flagged as doctor shoppers or high-risk patients, even if their regular pharmacy is out of stock or they are traveling.
- Proposal: Allow patients the flexibility to change doctors if needed and to fill prescriptions at any licensed pharmacy without being flagged in the system. Patients with chronic pain conditions should have the same rights to choose their providers and access their medication regardless of location.
- Allow Flexibility for Additional Pain Management During Medical Procedures
- Context: If a patient with a chronic pain prescription requires additional medication for surgeries, dental procedures, or other short-term medical needs, they currently cannot receive more medication if they already have a prescription without being flagged as a doctor shopper or high-risk patient—even when additional pain control is medically justified. This lack of flexibility forces patients to endure severe pain during recovery.
- Proposal: Implement policies allowing physicians to prescribe additional medication for acute pain needs related to surgeries or medical procedures without penalizing patients for already having a chronic pain prescription and providers for prescribing to a patient who already receives a prescription for chronic pain.
- Address and Mitigate Pharmacy Shortages
- Context: Pharmacy shortages of pain medications have become common, leading patients to scramble to find a pharmacy with their prescription in stock. These shortages, coupled with restrictions on visiting multiple pharmacies, can leave patients without necessary medication for days or weeks.
- Proposal: Ensure that DEA distribution limitations are reasonable and that pain management medications remain available in all communities. Establish guidelines to allow patients to fill prescriptions at alternate pharmacies without raising “red flags” or suspicion when shortages occur. Although the DEA permits one electronic transfer per prescription, many pharmacies are reluctant to facilitate it, and both patients and providers are flagged each time a transfer occurs.
- End Invasive Prescription History Tracking
- Context: Currently, all patients prescribed controlled substances are entered into a government-accessible database that any doctor can access before prescribing medications. This practice, intended to prevent prescription abuse, instead creates a presumption of guilt, treating pain patients as though they are “registered drug users.” This overreach violates patient privacy and discourages doctors from prescribing even necessary medications.
- Proposal: Limit access to prescription history databases to cases where misuse or doctor shopping is reasonably suspected. Ensure that the database is used to address cases of abuse and not as a routine screening tool that infringes on patient privacy and creates stigma.
- Patient Input in Policy Development
- Context: Pain patients and advocacy groups currently have minimal influence over policies that directly impact their lives. As a result, many policies are created without a clear understanding of patient needs or realistic care scenarios, leading to restrictive and harmful regulations.
- Proposal: Establish a patient advisory board within governmental or regulatory bodies that develop opioid and pain management policies. This board should include pain patients, medical professionals, and advocates to ensure policies are compassionate, balanced, and focused on real patient needs.
- End the Stigma and Misconceptions Around Pain Medication Use
- Context: The current approach to opioid management often assumes that all opioid use is inherently dangerous, creating stigma and distrust. There’s a misconception that anyone prescribed opioids is at immediate risk of addiction, which unfairly stigmatizes patients who rely on these medications for long-term pain management. Patients are often labeled as “drug-seeking” if they visit the ER, even when seeking care for genuine emergencies, and this stigma leads many to avoid the ER entirely. Pain patients are often unfairly blamed for the opioid crisis, which leads to discrimination, judgment, and isolation.
- Proposal: Launch a public awareness campaign that educates on the difference between medical dependence and addiction. Highlight the fact that most pain patients use their medication responsibly and require it to maintain a quality of life. Compassionate policies should be promoted to reduce stigma and support legitimate pain patients.
- Shift Focus to Addiction Prevention and Treatment Rather Than Blanket Prescription Restrictions
- Context: Although there is no evidence that reducing prescription opioids prevents addiction, most government policies created to “prevent addiction” largely focus on opioid reduction. Government funding and resources should prioritize evidence-based addiction prevention, mental health support, and accessible rehabilitation services. Treat addiction as a public health issue and avoid criminalizing medical providers who prescribe necessary pain medication for legitimate conditions.
- Proposal: Redirect resources from restrictive policies and broad distribution cuts to addiction prevention programs, community-based support systems, and comprehensive addiction treatment. Establish balanced, evidence-based policies that protect patients’ rights while addressing the root causes of the addiction crisis.
- Reassess the Red Flags Used to Flag Outlier Prescribers and Patients
- Context: The current red flags are based on outdated criteria, often targeting the sickest patients with the most complex illnesses. These flags were initially created in the 1990s and updated in 2016, but despite recent CDC updates, they remain embedded in the policies of 38 states, medical board rules, and payer systems, causing harm to providers and patients.
- Proposal: Remove outdated red flags from all systems and policies. Work with pain management experts to reassess these criteria to prevent harm to legitimate patients and providers.
- Ensure Transparency and Regulation of PDMP-Based Risk Score Algorithms
- Context: Risk score algorithms in the Prescription Drug Monitoring Program (PDMP) often inform medical decisions yet lack transparency due to proprietary protections. This lack of oversight has led to patient harm.
- Proposal: Make the data points used in NarxCare and similar algorithms publicly available. Ensure FDA regulation of all healthcare algorithms that affect medical decisions, removing outdated and harmful data sources.
Expected Outcomes
By removing excessive restrictions and unnecessary barriers, chronic pain patients will have better access to the treatment they need, improving their quality of life and mental health. Healthcare providers will be able to provide patient-centered care without fear of legal repercussions, and government resources will be redirected to support addiction prevention and treatment initiatives. These changes will create a more compassionate healthcare environment that respects patients’ dignity, autonomy, and right to effective pain management.
Conclusion
The restrictive policies resulting from the “war on opioids” have harmed countless patients who rely on pain medication to maintain a manageable life. People are not dying from responsibly used prescription opioids; they are dying from illicit street drugs like fentanyl, which many turn to out of desperation when they cannot access their prescribed medications. This proposal urges policymakers to reconsider these regulations and shift focus to targeted, evidence-based addiction prevention and compassionate care. Pain patients deserve to be treated with dignity and respect, not punished for the actions of a minority. Let’s end the stigma, prioritize patient-centered policies, and protect the rights of pain patients who deserve access to the treatment they need.
For inquiries or questions regarding advocacy, please reach out to Claudia Merandi, who is serving as the spokesperson for this policy. You can contact her directly on this platform under the username “ClaudiaMerandi” or via email at cmerandie@gmail.com.