MISSOURI EARNS 'C' AT MANAGING PAIN, REGULATING OPIOIDS

The General Assembly might make access to drugs more difficult.

Missouri's policies on pain management meet - but don't yet beat - the
national average, according to a new report from researchers at the
University of Wisconsin. But a new council established this year by the
Missouri General Assembly could change legislation that hinders patients'
access to drugs for chronic and acute pain.

Missouri earned a "C" overall for its policies on prescribing and
regulating opioid drugs to control pain in a state-by-state evaluation that
included the District of Columbia. That is up from a "D" in March 2000. No
states scored an "A" or "F" overall.

Opioid analgesics were chosen for the study, "Achieving Balance in a State
Pain Policy: A Progress Report Card," because they are a mainstay for
treating long-term or severe pain and are needed to maintain public health.
Opioid analgesics are controlled substances that include morphine and
oxycodone.

Policies in states that received high grades balanced patient access to the
drugs with prevention of abuse and addiction, said Aaron Gilson, assistant
director of the university's Pain and Policy Study Group and an author of
the report. Right now, "the balance is tipped against patients," he said.

"Our study is not about making it easier for abusers to get drugs," Gilson
said. "It's about making it easier for patients to get drugs."

States were given low grades if their policy language promoted
misconceptions about addiction; required government monitoring of patients
using the drugs;imposed undue limits on the amount that can be prescribed;
or suggested that opioids are a last resort or hasten death.

Missouri was one of only 14 states that improved its overall grade compared
to March 2000 grades, which were calculated for comparison. Each grade was
divided into two parts - a positive grade for the promotion of pain
management and a negative grade for impeding it. But for Missouri, only
one, the positive grade, improved.

Gilson said guidelines for the use of controlled substances, adopted in
2001 by Missouri's Board of Healing Arts, deserved much of the credit for
the improvement, raising the positive grade from a C to an A. The board
issues licenses to practice medicine in the state, but not to prescribe drugs.

John Heidy, chief investigator of the Board of Healing Arts, said
practitioners in the past had been concerned about retaliation from
regulatory agencies. But as long as physicians document their reasons for
prescribing controlled drugs, they should not have any fears, he said.

Ambiguous or negative statements in relevant state laws landed Missouri an
F for negative elements, for a C overall in 2003. The same state laws had
received an F in 2000, bringing its composite grade to a D that year.

The researchers faulted Missouri's Controlled Substances and Intractable
Pain Treatment acts for including passages that were ambiguous or were
restrictive to doctors and other practitioners who prescribe or recommend
drugs.

All that could change soon.

In July, Gov. Bob Holden approved a bill that established the Missouri
State Advisory Council on Pain and Symptom Management. The council will
recommend acute and chronic pain management practices based on public
hearings, review pain-management-education guidelines and practices, and
"analyze statutes, rules and regulations relating to pain management," the
Senate Web site said.

Pain management is one of the issues at the forefront of modern health
care, said Sen. Charlie Shields, R-St. Joseph. The bill was later passed as
part of another House bill. "Missouri did not have anything in our
legislature that addressed that," said Shields, sponsor of the original
Senate bill.

The council will also report annually to the governor and can recommend
changes in state policy on pain management on a case-by-case basis.

"If the council meets and tells us we need changes, then we'll move
forward," Shields said.

Although the bill was proposed by the American Cancer Society, the
council's role is not limited to cancer issues.

Gilson was encouraged to hear of the council and its potential for
educating the medical community. But he said changing restrictive language
in laws could sometimes take a lot of effort.

Kansas was one of just four states with a B-plus, the highest overall grade.

"It's very easy for states that received a B-plus to get an A simply by
removing some restrictive language," Gilson said.

Iowa earned a B overall, while Illinois received one of the lowest grades,
a D-plus.

The report was supported by the Robert Wood Johnson Foundation. It was a
"black-letter policy evaluation," meaning policies are graded solely by
their language and not their implied or intended effects, Gilson said.