Pain Management In Addiction Medicine
U. S. Department of
Drug Enforcement Administration
Washington, D.C. 20537
March 3, 2000
Howard Heit, M.D., F.A.C.P., F.A.S.A.M.
8316 Arlington Boulevard
Fairfax, Virginia 22031-5216
Dear Dr. Heit:
This is in response to your letter regarding pain management and narcotic
Pain specialists may treat a chronic pain patient currently enrolled in a
narcotic treatment program with narcotics: ~ The Controlled Substances Act does
not set standards of medical practice. It is the responsibility of individual
practitioners to treat patients according to their professional judgment for a
legitimate medical purpose in accordance with generally acceptable medical
As you know, state boards of medical examiners establish standards of medical
practice and regulate such practice by doctors and other practitioners in their
states. Many states have undertaken actions to develop guidelines for pain
treatment. A booklet entitled "Model
Guidelines for the Use of Controlled Substances for the Treatment of Pain,"
is enclosed for your use. You may also wish to contact your state medical
authorities or other nationally recognized organizations such as the American
Methadone Treatment Association, the American Society for Addiction Medicine, or
the American Academy of Pain Medicine.
specialists may treat a chronic pain patient currently enrolled in a narcotic
treatment program, they may only treat the patient's pain. Care of patients
fighting substance abuse requires sensitivity to the issue and careful
monitoring of outcomes. As a suggestion, you may wish to obtain the patient's
permission to coordinate your pain management treatment with his/her narcotic
If a practitioner wishes to provide detoxification treatment or maintenance
treatment to narcotic dependent persons, a separate registration with the Drug
Enforcement Administration (DEA) as a narcotic treatment program is required. A
registration as a narcotic treatment program will allow the practitioner to
administer or directly dispense, but not prescribe, narcotic drugs. Currently,
methadone and levo-alpha-acetyl-methadol (LAAM) are the only controlled
substances approved for maintenance and/or detoxification treatment.
Buprenorphine, single entity or in combination with Naloxone, has not yet
received approval from the U.S. Food and Drug Administration (FDA) and National
Institute for Drug Abuse (NIDA) for narcotic addiction treatment.
I hope this information is useful to you. If you have any further questions,
please do not hesitate to contact this office at 202-307-7286.
Patricia M. Good, Chief
Liaison and Policy Section
Office of Diversion Control
cc: DPM Kathy Daniels, DPM
Mary Johnson-Rochee, G/S