The DEA’s Withdrawal of Pain Management Guidelines

In November 2004, the U.S. Drug Enforcement Administration (DEA) announced that it had withdrawn the guidelines on dispensing of controlled substances for the treatment of pain that it had released in August 2004. The guidelines were developed over a period of several years with input from experts in pain medicine and included information to assist physicians in providing treatment while also preventing medication diversion. The DEA withdrew the guidelines citing concerns about misstatements, particularly regarding refills and reselling of schedule II controlled substances.

The August guidelines stated that physicians could prepare multiple prescriptions on the same day with instructions to fill the prescriptions on different dates. However, in the withdrawal, the DEA indicated that this practice is often used by physicians seeking to avoid detection when dispensing controlled substances for unlawful purposes. While the DEA has stated that the guidelines are a reiteration of the existing Controlled Substances Act (CSA), the previous statement contradicts the current practice of many physicians.

In its withdrawal, the DEA noted that it would be issuing a comprehensive reiteration and clarification of existing guidelines in the future that would address in detail dispensing of controlled substances for the treatment of pain. The DEA published a notice in the January 18, 2005, Federal Register requesting comments on what areas of the law relating to dispensing of controlled substances for the treatment of pain should be addressed in the DEA policy guidelines. The Academy submitted a comment letter on this issue and developed a sample comment letter for members to use. When the DEA guidelines become available, information will be published in The Physiatrist as well as on the Academy’s Web site.