Remarks by Dr. William Jacobs
Co-Founder and President of NexStep Integrated Pain Care
Media Roundtable on Dispensing Controlled
Substances for the Treatment of Pain
Arlington, Virginia
September 6, 2006

Thank you, Administrator Tandy and the United States Drug Enforcement Administration for allowing me the opportunity to join you and my friend and colleague Dr. Bob Dupont here today. I am speaking from the point of view of a physician in private practice treating patients with chronic pain problems, drug abuse problems or both.

We are here today because there has been a paradigm shift in the prescribing of controlled substances in this country over the past decade. We have become much more aggressive in the treatment of pain and many patients have benefited from this change.

This has resulted in a dramatic increase in the availability of controlled substances, primarily opioid pain medicines and has been accompanied by equally dramatic increases in diversion, abuse and addiction to these substances.

The pain management and addiction medicine communities have worked with the Federation of State Medical Boards to create Model Guidelines for the treatment of intractable pain. Many states have adopted these guidelines into law. The DEA has an obligation under the law and to the public to ensure that controlled substances are prescribed and dispensed only for legitimate medical purposes in accordance with the Controlled Substances Act.

The release of the DEA’s Policy Statement today reemphasizes the administration’s commitment to fulfill those obligations while leaving medical decision making in the hands of medical practitioners.

  • The Center on Addiction and Substance Abuse’s (CASA) recent survey of physicians found that
    • doctors believe that they bear primary responsibility for preventing prescription drug diversion and abuse.
  • however, only
    • 19 percent received training in prescription drug diversion in medical school
    • Only 39 percent in residency
    • And only 34 percent through continuing medical education

In addition to being inadequately trained to treat these common medical conditions (chronic pain and addiction), many physicians are not well versed on the laws and regulations on both federal and state levels governing the prescribing of controlled substances for the treatment of chronic pain.

As physicians we need to correct this educational deficiency. This first of its kind Policy Statement should be required study for every physician whose practice includes prescribing controlled substances.

In addition to the Policy Statement, DEA today announced proposed rulemaking regarding schedule II prescribing. Schedule II opioid medications make up the most potent medicines we have to treat pain. The notice of proposed rulemaking to allow doctors to provide patients with multiple prescriptions for schedule II controlled substances that are to be filled sequentially is another initiative from the DEA to help doctors provide appropriate care for patients with chronic pain. It would allow stable patients who do not need to be seen on a monthly basis to receive multiple prescriptions for the same schedule II controlled substance at a single office visit which would provide them with a maximum 90 day supply. It also would allow doctors the flexibility to issue multiple prescriptions of shorter durations and effectively limit the total number of doses dispensed at a single time.

This proposed rule is clearly beneficial to the practice of good medicine and should help prevent, certainly not promote, diversion, abuse or addiction. This is a good example of the progress that can be made when physicians collaborate with the DEA.

I urge all physicians to learn the facts about how and why the DEA investigates a doctor on the newly added webpage. There is no giant computer counting the number of prescriptions or pills a physician writes and then signaling a SWAT team attack on a physician’s office. There has been a significant amount of misinformation propagated about some of the more public cases. In most cases the DEA becomes aware of a doctor selling prescriptions from local pharmacists or physicians. Physicians who know the rules and follow them have nothing to fear from the DEA. In fact, I invite them to join me in supporting the DEA’s efforts to combat doctor shopping and prescription fraud, sharing of medicines among family and friends, and illegal online pharmacies. Less than 1% of physicians do not practice medicine but rather sell prescriptions for controlled substances. In addition to breaking the law, these doctors do great harm to the public and the medical profession.

Finding the balance between adequately treating chronic pain and monitoring and treating diversion, abuse and addiction remains a significant challenge. It is important for physicians to continue to work with the DEA and to utilize the Policy Statement, Proposed Rulemaking and Website information provided by Administrator Tandy today.

I thank you again for the opportunity to present a practicing physician’s prospective on these important issues.