| Position Statements |
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| Treatment and Management of Pain |
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Adopted June 2006
Healthcare leaders and patient advocates have come together in a legislatively mandated pain commission to work toward providing well managed and adequate pain control to the citizens of Oregon. Involvement with The Oregon Pain Commission has prompted the Board of Pharmacy to take a leadership role in promoting the effective management of pain for the state’s citizens. The mission of the Oregon Board of Pharmacy is to promote, preserve and protect the public health, safety and welfare by regulating the practice of pharmacy and the distribution of drugs within and into the state. As a part of that endeavor, the Board strives to ensure that all Oregonians have access to appropriate pain relief. Appropriate and effective pain therapies, including the use of controlled substance medications, can greatly improve a patient’s quality of life and reduce unnecessary morbidity and cost associated with inadequate treatment of pain.
Inadequate pain control, in some cases, may result from a lack of knowledge or understanding of proper pain management by health care professionals and patients. Under-treatment of pain can also be the result of fear or misunderstanding of the position of regulatory boards or law enforcement agencies regarding the use of controlled substances in the treatment and management of pain. This statement is intended to clarify the Board of Pharmacy’s position regarding pain management in the practice of pharmacy.
The Oregon Board of Pharmacy recognizes that the use of controlled substances, including opioid analgesics, is often essential for the treatment and management of both acute and chronic pain of any origin. A pharmacist involved in the care of a patient undergoing treatment for pain should not fear disciplinary action from the board for dispensing controlled substances, including opioid analgesics, for a legitimate medical purpose as defined in the state of Oregon. Pharmacists' involvement with pain management in the usual course of their professional practice should be based upon accepted scientific knowledge and sound clinical judgment.
The Board of Pharmacy also recognizes that controlled substances, by their nature, carry with them a risk of abuse or misuse. All health care professionals must remain alert to the fact that these drugs are subject to abuse and that some people will seek them for inappropriate uses. Care must be taken to balance this risk with the desired outcome of effective pain control for all who are in need.
Dispensing of controlled substances for the treatment of pain must be based upon a valid prescription issued within currently accepted standards. All pharmacists are encouraged to increase their knowledge of current medical standards for the treatment of pain and develop effective strategies for delivering pharmaceutical care to patients suffering with pain. Pharmacists should actively participate on the health care team by providing expertise to the patient, physician, nurse and hospice provider or other care giver. As a member of the health care team, pharmacists can contribute to positive therapeutic outcomes for patients suffering from pain and can reduce the potential for drug abuse. Detailed documentation of the patient’s medical condition and clinical response to treatment provides the strongest foundation for providing optimal patient care.
The Board acknowledges the review of position statements from the Iowa, Michigan, Wisconsin, and Texas Boards of Pharmacy as well as the Oregon Board of Nursing and the Oregon Board of Medical Examiners and the Oregon Pain Commission in developing this Position Statement on the Treatment and Management of Pain.
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| Considering Moral and Ethical Objections |
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Revised February 2007
No provision exists within Oregon pharmacy laws or regulations that require a pharmacist to dispense every lawful prescription presented in a pharmacy. Indeed, pharmacy laws and regulations require a pharmacist to delay the dispensing of a prescription when faced with questions of potential harm to a patient or concerns of clinical appropriateness of a drug, a dose, or a dosage form for a particular patient. Pharmacists are required to seek clarification prior to dispensing and to collaborate with prescribing practitioners in the patient's best interest.
Just as other health care professionals and practitioners in Oregon have a choice, so do pharmacists have a choice whether or not to participate in activities they find morally or ethically objectionable. Oregon pharmacists cannot however, interfere with a patient's lawfully and appropriately prescribed drug therapy or request for drugs and devices approved by the U.S. Food and Drug Administration (FDA) for restricted distribution by pharmacies. Pharmacists enter into relationships with patients in the daily course of normal pharmacy practice. Within these relationships pharmacists have a duty to provide professional pharmaceutical care in the patient's interest.
The Board of Pharmacy expects each Oregon Pharmacist-in-Charge (PIC) to adopt written policies and procedures that address the issues of pharmacists' moral, ethical and professional responsibilities. It is the Board's belief that pharmacy policies and procedures could allow a pharmacist to exercise his or her choice to not participate, and at the same time not interfere with the patient's right to receive appropriate and lawfully prescribed drug therapy or drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies. These may include dispensing of the prescription or drug or device by another pharmacist on site or arranging for the prescription to be dispensed by a pharmacist at another site. The Board also expects Oregon pharmacists to discuss issues of moral, ethical and professional responsibilities with their Pharmacist-In-Charge and to understand and comply with the pharmacy’s policies and procedures.
The Board expects that pharmacy policies and procedures will ensure patients in Oregon always receive appropriate and lawfully prescribed medications and information or drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies in a timely and professional manner and that patients are not burdened by the pharmacist's individual beliefs. Interference with a patient’s right to receive timely, professional prescription services and information or drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies may be considered unprofessional conduct and could result in disciplinary action by the Board. (See attached “Clarification”)
Position Statement History
Originally Adopted September 2005
Revised February 2007
Clarification
For Example, the Board would consider it unprofessional conduct for a pharmacist to lecture a patient about the pharmacist’s moral or religious beliefs, to violate the patient’s privacy or to destroy, confiscate or otherwise tamper with the patient’s prescription.
The written policy should require an objecting pharmacist to inform the PIC in advance so that the PIC can reasonably accommodate that objection before a patient presents a prescription or makes a request for drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies. The accommodation may not include permission to lecture the patient. The policy should also ensure that the patient's prescription or drug and device needs are met either by ordering the drug, if it is not in stock, pursuant to the usual pharmacy policies, by transferring or returning the prescription to the patient if the patient requests, or by referring the patient to another pharmacy nearby where the patient can get the prescription filled or receive drugs and devices approved by the U.S. FDA for restricted distribution by pharmacies. In the event of a referral, the pharmacist is responsible for identifying another pharmacy that has the medication in stock and will dispense the prescription or dispense drugs or devices approved by the U.S. FDA for restricted distribution by pharmacies.
Pharmacists licensed in Oregon may seek clarification of questions or concerns about moral or ethical objections from the Board of Pharmacy. Patients who believe they have been inappropriately refused medication may file a complaint with the Board of Pharmacy. Information about the complaint process can be found on the Board’s website at: www.oregon.gov/Pharmacy/complaint.shtml
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