Question 11: Is education key?

Raymond Sinatra, MD: Great, final question for Commander Burke, education is still the key isn't it?

Commander John Burke: Absolutely.

Raymond Sinatra, MD: Who's responsible ... first of all can you explain why education is so important and then who is going to be responsible for providing that education? One of the problems I see is many community physicians are not knowledgeable in opioids as a class and they're not ... they don't realize the potency, the duration, side effect profile, this that and the other thing. Who's going to be responsible for this education, special licensing needs, whatever?

Commander John Burke: Well, I think it's an excellent point because I do think that is the final key to this problem. And I think it needs to start and it already has in medical schools with introduction of pain management courses. But I'd really like to see an hour or two in these major medical schools devoted to drug diversion and bringing in somebody very knowledgeable that's done these cases and just give physicians a little bit of an idea before they enter the world, a little bit about drug diversion. I think that's the important.

The other thing that of course is important for the kind of people that you're talking about is certainly some ... again, education from law enforcement and regulators as far as diversion scams and talking about some of the things that they can watch out for, but I also think that it's highly important for pain management specialists to be able to speak to these folks, to these primary care providers about ... you know, pain management and about proper prescribing. And I think that will go a long way in helping to try and curb this problem. I think that's better the way to get this done than what's being done now.

The other thing is that we try and do from our side, and believe me we are from the NADDI side, the law enforcement side, more than willing to participate any way we can and I do that on a regular basis ... speaking to physicians about diversion and how to prevent becoming a target of it. Then we on our side need to ... which we have done ... make sure that we offer a significant amount of education from pain specialists and we do, to our members, so that they better understand pain management ... it's very crucial that we know more and more about that.

Raymond Sinatra, MD: Great. Before I move on to selected questions from members of Anesthesia Web, does anyone have any other points that they'd like to make at this time?

Neil Jobalia, MD: I just wanted to say that the last thing that Commander Burke has alluded to is a very important concept when we're talking about diversion, the education going both ways. Both the physicians being educated by people with experience in drug diversion and the other way around. And it leads to kind of what I think ... as far as diversion is concerned, probably the best thing that we can have is coordination and I think that would not only ... opening lines of communication leads to a higher level of comfort among physicians knowing that the police officer isn't someone who's kind of lurking around the corner waiting to slap the cuffs on him, you know, which unfortunately a lot of physicians do have that view. And also from the law enforcement point of view that physicians are simply just facilitating this whole process by freely prescribing pain medications to anybody who walks in their office.

L. Jean Dunegan, MD, JD, FCLM: ... just in Oregon back in 1999, and in June of this year we saw a lengthy civil case resulting in the California jury's award of $1.5 million to the adult children of a man whose palliative care included very poor pain management ... according to the jury's verdict. So we are beginning to see a pendulum shift in the actual standard of care being that we not only better take pain seriously in individual patients, but we better begin to communicate with patients and their families regarding our efforts to try to manage people's suffering and pain.

David Joranson, MSSW: Commander Burke's essential offer of diversion investigators to be a part of the education of physicians about drug diversion I think is something that people really should take advantage of. I know that the Drug Enforcement Administration has made themselves available to many conferences of pain management specialists in an effort to create this kind of a dialogue. And I think that there is some shifting going on there, in fact, I think that the initial comment that was made in one of the big newspapers about rolling back the production quotas for oxycodone to 1996 levels, you'll find that that does not appear in some of the more recent public comments of DEA.

And just one more thing, and that is for physicians who want to know more about the status of law and regulation and medical board guidelines in their own states, the website of the Pain and Policy Studies Group [http://www.medsch.wisc.edu/painpolicy/] does contain a complete full text database of all of those policies plus federal controlled substances regulations, and that can be easily found by just doing a search for pain policy.