Better State Guidelines for Use of Opioid Analgesics

Guidelines for the Chronic Use of Opioid Analgesics from State Medical Boards Opioid Guidelines As Adopted April 2017_FINAL.pdf

Adopted as policy by the Federation of State Medical Boards April 2017


In April 2015, the Federation of State Medical Boards (FSMB) Chair, J. Daniel Gifford, MD, FACP, appointed the Workgroup on FSMB’s Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain to review the current science for treating chronic pain with opioid analgesics and to revise the Model Policy as appropriate.

In updating its existing policy, the FSMB sought input from a diverse group of medical and policy stakeholders that ranged from experts in pain medicine and addiction to government officials and other thought leaders. 

This what the CDC should have done as well, but did not. 

Over the course of the last 12 months, the workgroup met on several occasions to examine and explore the key elements required to ensure FSMB’s policy document remains relevant and is sufficiently comprehensive to serve as a prescribing guideline and resource for state medical and osteopathic boards and clinicians.

This policy document includes relevant recommendations identified by the workgroup, and is in keeping with recent releases of advisories issued by the CDC and FDA.

This policy is intended as a resource providing overall guidance to state medical and osteopathic boards in assessing physicians’ management of pain in their patients and whether opioid analgesics are used in a medically appropriate manner


Section 1 – PREAMBLE

The diagnosis and treatment of pain is integral to the practice of medicine


The focus of the Guidelines that follow is on the general overall safe and evidence-based prescribing of opioids and treatment of chronic, non-cancer pain with the specific limitation and restriction that these Guidelines do not operate to create any specific standard of care, which standard must depend upon fact-specific totality of circumstances surrounding specific quality-of-care events.

This is exactly what the CDC guideline is missing: acknowledgment of individual differences.

The Guidelines recognize that there is not just one appropriate strategy to accomplish the goals of these Guidelines.

Effective means of achieving the goals of these Guidelines vary widely depending on

  • the type and causes of the patient’s pain,
  • the preferences of the clinician and the patient,
  • the resources available at the time of care, and
  • other concurrent issues beyond the scope of these Guidelines.

These Guidelines that follow do not encourage the prescribing of opioids over other pharmacological and nonpharmacological means of treatment but rather the Guidelines recognize the responsibility of clinicians to view pain management as essential to quality of medical practice and to the quality of life for patients who suffer from pain.

These Guidelines may apply most directly to the treatment of chronic pain lasting more than three months in duration or past the time of normal tissue healing, however many of the strategies mentioned here are also relevant to responsible prescribing and the mitigation of risks associated with other controlled substances in the treatment of pain.

The document is worth a read:

Opioid Guidelines As Adopted April 2017_FINAL.pdf


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