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Journal of Law Medicine & Ethics

Symposium Articles

Introduction
Providing Relief to Those in Pain: A Retrospective on the Scholarship and Impact of the Mayday Project [PDF]
Sandra H. Johnson
Since the inception of the Mayday Project at the American Society of Law, Medicine & Ethics in 1995, there has been a significant change in the legal environment for the prescription of controlled substances for pain management. This positive change is evidenced in the passage of pain relief acts by several states, the development of standards for state medical boards, and a change in attitudes among those boards. The Mayday Project, particularly through the scholarship published in the Journal of Law, Medicine & Ethics, played a significant role in the development of this improvement in public policy.

Achieving the Right Balance in Oversight of Physician Opioid Prescribing for Pain: The Role of State Medical Boards [PDF]
Diane E. Hoffmann and Anita J. Tarzian
To better understand how state medical boards are evaluating and balancing the need for adequate pain treatment with concerns about drug diversion and inappropriate prescribing, the authors undertook a survey of state medical boards across the country. This article, after briefly describing the evaluation of medical knowledge regarding the treatment of pain, the history of efforts to regulate controlled substances used to treat pain, and the literature regarding physician concerns about legal repercussions for prescribing opioids, reports on the survey results.

Maximizing the Value of Electronic Prescription Monitoring Programs [PDF]
David B. Brushwood
Electronic prescription monitoring programs have been established in approximately seventeen states, and legislation has been introduced into Congress that would create a national program. The goal of these programs is to reduce controlled substance diversion, without adversely affecting the appropriate use of controlled substances for pain and other medical conditions. This article questions whether this goal is being achieved and offers five key factors that can maximize the value of electronic prescription monitoring programs: comprehensiveness, expert analysis, timely and meaningful feedback, clear standards, and periodic program review.

Challenges in the Federal Regulation of Pain Management Technologies [PDF]
Lars Noah
This article considers the roles played by the Food and Drug Administration (an agency focused on medical and scientific questions) and the Drug Enforcement Administration (an agency preoccupied with law enforcement matters) in regulating a variety of different pain management technologies, especially narcotic analgesics such as OxyContin.

Pain Relief, Prescription Drugs, and Prosecution: A Four-State Survey of
Chief Prosecutors [PDF]
Stephen J. Ziegler and Nicholas P. Lovrich, Jr.
Physicians often undermedicate their patients out of fear that their aggressive treatment of pain with opioid analgesics will increase the likelihood of investigation or prosecution. Is this fear based in reality, and if so, what factors contribute to and predict its likelihood? This study surveys chief prosecutors in the states of Connecticut, Maryland, Oregon, and Washington in an effort to empirically assess the likelihood of investigation or prosecution in the context of pain relief.

Monitoring and Investigating Certified Registered Nurse Practitioners in Pain Management [PDF]
Jean B. Lazarus and Belinda (Wendy) Downing
This article reports on the results of a survey of nurse practitioners certified for practice in Alabama, where nurse practitioners in collaborative practice have legal restrictions on prescribing medications, particularly controlled substances used for treatment of pain. Survey participants were asked to comment on barriers to pain management, their preparedness for prescriptive practice, and the need for monitoring and investigating nurse practitioners’ compliance with collaborative practice protocols. Investigators from the Alabama Board of Nursing and the Board of Medical Examiners and other state boards of nursing were also surveyed.