State Initiatives Aim to Improve Pain Relief

ANNAPOLIS, Md--"Of the 1 million people diagnosed with cancereach year, at least half will not receive adequate pain control,"said June L. Dahl, PhD, professor of pharmacology, Universityof Wisconsin Medical School, and chair, Wisconsin Cancer PainInitiative.

Dr. Dahl was the keynote speaker at a conference on cancer painrelief strategies sponsored by the Maryland Cancer Pain Initiativeand the American Cancer Society. "Uncontrolled pain decreasesthe quality of patients' lives, leads to depression and anxiety,and may even adversely affect the course of the disease,"she said.

All states except Alaska, Alabama, Idaho, Montana, and Wyominghave cancer pain initiatives--volunteer efforts by health professionalswho work in clinical care facilities, institutions of higher education,and government, often in cooperation with the American CancerSociety and other health organizations.

The two key elements of a state initiative are education and advocacy,specifically to help health professionals acquire and apply knowledgeand skills to assess and treat cancer pain appropriately; educatepatients and families about drug and nondrug therapies to relievepain; and dispel fears about pain medications.

Nurses comprise the majority membership in state initiatives,Dr. Dahl said, but there are also significant numbers of physiciansand pharmacists.

The groups receive grants from the American Cancer Society andthe pharmaceutical industry to support their work. In addition,many initiative leaders contribute their services as part of theirregular professional responsibilities.

Members of state initiatives make presentations at professionalmeetings; distribute information about cancer pain relief to thepublic, health professionals, and the media; and monitor lawsand regulations that are now or might become barriers to cancerpain control.

Government-Issued Forms

One barrier to pain control is government-issued prescriptionforms (often referred to as triplicate forms) for Schedule IIcontrolled substances. These are required by Michigan, Texas,New York, California, and other states, said Robert T. Angarola,of the Washington, DC, law firm of Hyman, Phelps & McNamara,which specializes in food and drug law.

"Percodan, Demerol, Dilaudid, and morphine are the four mostcommonly prescribed Schedule II opioid analgesics," Mr. Angarolasaid. Very soon after the implementation of government-issuedforms in these states, the number of prescriptions for ScheduleII controlled substances dropped significantly--by 64% in Texas,for example.

"One copy of these forms goes to the state police or a regulatoryagency, but they don't use them to catch the bad guys: doctorsor pharmacists who direct these drugs to the illicit market,"Mr. Angarola said. "The people who suffer are cancer patientswho are not prescribed morphine and the other drugs they need."

State cancer pain initiatives can be instrumental in lobbyingagainst legislation that allows states to inhibit the appropriateprescribing of opioid analgesics, he said. The Maryland CancerPain Initiative, for example, played a role in the decision bythat state's legislature to vote down a bill that would have establisheda government-issued multiple-copy prescription program.

Barriers to the Appropriate Management of Cancer Pain

For More Information

For more information about cancer pain management, contact theResource Center for State Cancer Pain Initiatives, 1300 UniversityAvenue, Room 3671, Madison, WI 53706. Phone: 608-265-4013. Fax:608-265-4014. E-mail address: jcwineke@facstaff.wisc.edu.