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Report from the interagency committee on pain and analgesia: A public health service initiative
244
Ibl. I No. 4 Fall 1986
Journal of Pain and Symptom Management INFORMATION EXCHANGE
Report from the Interagency Committee on Pain and Analgesia: A Public Health Service Initiative Theodore M. Pinkert
Tile Interagency Committee on Pain and Analgesia (ICPA), chartered by the Assistaut Secretary for H e a h h in May 1985, is the most recent expression o f the continuing federal interest in improving the treatment o f patients suffering from pain. It is composed o f representatives o f all major federal heahh agencies as well as representatives o f all executive branch departments having a program o r an interest in pain. In a previous communication in the Journal, the charter and objectives of the ICPA were detailed, and tile projected activities o f the several subcommittees (into which the ICPA is subdivided) in carrying out these objectives, were described in brief. This r e p o r t will summarize a n u m b e r of the accomplishments o f the ICPA's first year o f operation, and the expectations we have for the future.
Research Recommendatim~s O n e o f the first activities o f tile ICPA (Subcommittee on Research) was tile convening o f a national meeting o f key research scientists to examine the need for alternatives to standard morphine preparations in the treatment o f cancer patients with advanced disease. This meeting also e x p l o r e d potentially rewarding research opportunities in the area of new drugs or unique methods o f drug administration. T h e i r recommendations included: 9 Encouraging further studies on the effects o f opiate drugs in cancer patients and o t h e r chronic pain patients d u r i n g long-term o r repeated use; 9 Carrying out studies that compare drug levels and degree o f analgesia following different routes o f drug admiuistration, to determine the relative efficacy o f new routes of administration (intrathecal, transdermal, etc) for both currently available and new analgesic agents;
Theodore M. Pinkert. MD,JD, is Deputy Director of the Division of Preclinical Research of the National Institute on Drug Abuse. tte is a member of the Interagency Committee on Pain and Analgesia.
9 S u p p o r t i n g further comparative analgesic studies with the sublingual form of buprenorphine; 9 Pursuing further investigations into tim mechanism and control o f pain that responds poorly to opiates. Steps to implement these recommendations are now underwa):
Liaison zoith NASCSA A n o t h e r early activity o f the ICPA (Subcommittee on Drug Availability a n d Legislation) was the establishment of a liaison with the National Association of State Controlled Substances Authorities (NASCSA). NASCSA was then a new organization established among the states to deal with drug regulatory problems that were shared by its members. The ICPA was invited to send representatives to NASCSA's first annual meeting. There they presented the ICPA's concerns to NASCSA regarding possible regulatory i m p e d i m e n t s to the availability of scheduled drugs (opiates) used for the treatment o f pain: that is, whether a p p r o p r i a t e regulatory efforts to control d r u g diversion and misuse have had the u n i n t e n d e d consequence o f creating a "chilling effect" u p o n tile p r o p e r prescribing and dispensing o f these drugs for patients in seriotis pain, particularly for patients with pain secondary to terminal cancer. An important d i a l o g u e . between regulators and h e a h h care providers ensued which discussed mechanisms to get out the xnessage to tile heahh care provider community that providers do not j e o p a r d i z e their standing in the community (or with the regulatory authorities) by making strong analgesics available to patients in severe pain. NASCSA also had concerns about the p r o p o s e d federal rescheduling (from Schedule I to Schedule II) o f dronabinal for adjunctive treatment of canCer and whether the d r u g would continue to be available before the states could reschedule it according to their respective legislative o r regulatory processes. Working with several representatives o f l C P A m e m b e r agencies, solutions to the p r o b l e m o f drug availability emerged that ensured a continuing supply o f dronabinal to patients who would otherwise have been adversely affected.
Vol. 1 No. 4 Fall 1986
Journal of Pain and Symptom Management INFORMATION EXCHANGE
Support for WHO and Wisconsin bfftiative During the past }'ear, the ICPA received a request from the World Health Organization (WHO) to review and c o m m e n t on its plan to improve the management of chronic severe pain on a worldwide basis. The p l a n - - C o m p r e h e n s i v e Management of Cancer Pain--was perceived by the ICPA as an excellent b l u e p r i n t for action, and following a recommendation of support from the committee as a whole, the Office of the Assistant Secretary for Health issued a letter of support to the Director-General of WHO (Please refer to tile S u m m e r issue.ofJPSM). Another very important activity (that has been well covered in current and previous issues of the Journal) is the ICPA's evolving relationship with the State of Wisconsin's Informal Steering Committee to Improve Cancer Pain Management. The ICPA has been working with the Wisconsin group to help provide support and expertise for its major strategy session, and is honored to have been invited to participate as a co-sponsor of the project.
Private Sector Initiatives Recently an ICPA initiative, tentatively titled the "Pain Relief Project" was established. This is an effort to enlist some of the private sector's most influential health care provider organizations in taking on their own individual or shared initiatives to improve the management of pain with the coordination and assistance of the ICPA. O n J u n e 25,1986 the representatives of 13 health care providers and professional organizations met with members of the ICPA's Subcommittee on Education and Training at the National Institutes of Health to develop strategies for working with their memberships or constituency groups to develop these initiatives. Their projects will be designed to change professional attitudes and behavior with respect to pain management. It is hoped that we may soon be j o i n e d in tile Pain Project by members of organizations representing the public sector. ICPA members are looking forward to our second }'ear of activity and to working with an ever broader cross section of persons and organizations dedicated to improving tile quality of care for those in pain. For more information on the ICI'A, please contact:
Interagenc3' Committee on Pain and Analgesia Public Health Service Alcohol, Drug Abuse, a n d Mental Health Administration Department of Health and H u m a n Services 5600 Fishers La., Rm. 10-A-31 Rockville, MD 20857.
245
Ibl. I No. 4 Fall 1986
Journal of Pain and Symptom Management INFORMATION EXCHANGE
Report from the Interagency Committee on Pain and Analgesia: A Public Health Service Initiative Theodore M. Pinkert
Tile Interagency Committee on Pain and Analgesia (ICPA), chartered by the Assistaut Secretary for H e a h h in May 1985, is the most recent expression o f the continuing federal interest in improving the treatment o f patients suffering from pain. It is composed o f representatives o f all major federal heahh agencies as well as representatives o f all executive branch departments having a program o r an interest in pain. In a previous communication in the Journal, the charter and objectives of the ICPA were detailed, and tile projected activities o f the several subcommittees (into which the ICPA is subdivided) in carrying out these objectives, were described in brief. This r e p o r t will summarize a n u m b e r of the accomplishments o f the ICPA's first year o f operation, and the expectations we have for the future.
Research Recommendatim~s O n e o f the first activities o f tile ICPA (Subcommittee on Research) was tile convening o f a national meeting o f key research scientists to examine the need for alternatives to standard morphine preparations in the treatment o f cancer patients with advanced disease. This meeting also e x p l o r e d potentially rewarding research opportunities in the area of new drugs or unique methods o f drug administration. T h e i r recommendations included: 9 Encouraging further studies on the effects o f opiate drugs in cancer patients and o t h e r chronic pain patients d u r i n g long-term o r repeated use; 9 Carrying out studies that compare drug levels and degree o f analgesia following different routes o f drug admiuistration, to determine the relative efficacy o f new routes of administration (intrathecal, transdermal, etc) for both currently available and new analgesic agents;
Theodore M. Pinkert. MD,JD, is Deputy Director of the Division of Preclinical Research of the National Institute on Drug Abuse. tte is a member of the Interagency Committee on Pain and Analgesia.
9 S u p p o r t i n g further comparative analgesic studies with the sublingual form of buprenorphine; 9 Pursuing further investigations into tim mechanism and control o f pain that responds poorly to opiates. Steps to implement these recommendations are now underwa):
Liaison zoith NASCSA A n o t h e r early activity o f the ICPA (Subcommittee on Drug Availability a n d Legislation) was the establishment of a liaison with the National Association of State Controlled Substances Authorities (NASCSA). NASCSA was then a new organization established among the states to deal with drug regulatory problems that were shared by its members. The ICPA was invited to send representatives to NASCSA's first annual meeting. There they presented the ICPA's concerns to NASCSA regarding possible regulatory i m p e d i m e n t s to the availability of scheduled drugs (opiates) used for the treatment o f pain: that is, whether a p p r o p r i a t e regulatory efforts to control d r u g diversion and misuse have had the u n i n t e n d e d consequence o f creating a "chilling effect" u p o n tile p r o p e r prescribing and dispensing o f these drugs for patients in seriotis pain, particularly for patients with pain secondary to terminal cancer. An important d i a l o g u e . between regulators and h e a h h care providers ensued which discussed mechanisms to get out the xnessage to tile heahh care provider community that providers do not j e o p a r d i z e their standing in the community (or with the regulatory authorities) by making strong analgesics available to patients in severe pain. NASCSA also had concerns about the p r o p o s e d federal rescheduling (from Schedule I to Schedule II) o f dronabinal for adjunctive treatment of canCer and whether the d r u g would continue to be available before the states could reschedule it according to their respective legislative o r regulatory processes. Working with several representatives o f l C P A m e m b e r agencies, solutions to the p r o b l e m o f drug availability emerged that ensured a continuing supply o f dronabinal to patients who would otherwise have been adversely affected.
Vol. 1 No. 4 Fall 1986
Journal of Pain and Symptom Management INFORMATION EXCHANGE
Support for WHO and Wisconsin bfftiative During the past }'ear, the ICPA received a request from the World Health Organization (WHO) to review and c o m m e n t on its plan to improve the management of chronic severe pain on a worldwide basis. The p l a n - - C o m p r e h e n s i v e Management of Cancer Pain--was perceived by the ICPA as an excellent b l u e p r i n t for action, and following a recommendation of support from the committee as a whole, the Office of the Assistant Secretary for Health issued a letter of support to the Director-General of WHO (Please refer to tile S u m m e r issue.ofJPSM). Another very important activity (that has been well covered in current and previous issues of the Journal) is the ICPA's evolving relationship with the State of Wisconsin's Informal Steering Committee to Improve Cancer Pain Management. The ICPA has been working with the Wisconsin group to help provide support and expertise for its major strategy session, and is honored to have been invited to participate as a co-sponsor of the project.
Private Sector Initiatives Recently an ICPA initiative, tentatively titled the "Pain Relief Project" was established. This is an effort to enlist some of the private sector's most influential health care provider organizations in taking on their own individual or shared initiatives to improve the management of pain with the coordination and assistance of the ICPA. O n J u n e 25,1986 the representatives of 13 health care providers and professional organizations met with members of the ICPA's Subcommittee on Education and Training at the National Institutes of Health to develop strategies for working with their memberships or constituency groups to develop these initiatives. Their projects will be designed to change professional attitudes and behavior with respect to pain management. It is hoped that we may soon be j o i n e d in tile Pain Project by members of organizations representing the public sector. ICPA members are looking forward to our second }'ear of activity and to working with an ever broader cross section of persons and organizations dedicated to improving tile quality of care for those in pain. For more information on the ICI'A, please contact:
Interagenc3' Committee on Pain and Analgesia Public Health Service Alcohol, Drug Abuse, a n d Mental Health Administration Department of Health and H u m a n Services 5600 Fishers La., Rm. 10-A-31 Rockville, MD 20857.
245