updated 8/11/2004 5:50:46 PM ET 2004-08-11T21:50:46

Doctors cannot be arrested for properly prescribing narcotic painkillers that are the best treatment for millions of suffering patients, according to new guidelines from pain specialists and the Drug Enforcement Administration.

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The guidelines, written by leading pain specialists together with the DEA, come because many doctors hesitate to prescribe the powerful drugs, which are heavily regulated because they can be abused by addicts.

The new document for the first time spells out the exact steps doctors should take to ensure their patients get appropriate medical care without attracting DEA scrutiny. The idea is to get better pain treatment for Americans.

"There are many misconceptions about DEA's role ... that lead to unwarranted fear that doctors who treat pain aggressively are singled out," said Patricia Good, DEA's chief of prescription drug diversion.

The guidelines, being distributed Wednesday to DEA agents and physicians alike, should help eliminate "this aura of fear," Good added.

Serious pain problems going undertreated
The DEA regulates how doctors prescribe drugs that are controlled substances, such as opioid painkillers — morphine, codeine, fentanyl, Oxycontin — to ensure they're not diverted for illegal use.

The main message: "Pain medicine is not to contribute to abuse, and law enforcement is not to interfere in patient care," said David Joranson, director of pain policy at the University of Wisconsin-Madison Medical School, who helped write the guidelines.

Undertreatment of chronic, serious pain is considered a major medical problem. For example, painkillers known as opioids are considered standard of care for serious pain from cancer, AIDS and among the terminally ill, yet about 40 percent of those patients are undertreated, said Dr. Russell Portenoy, pain chief at Beth Israel Medical Center and a leading pain specialist.

The new guidelines spell out steps that ensure proper prescribing, such as records showing the doctor performed a clear medical history and physical examination to document the need for the painkiller.

Measuring pain intensity and extent of relief over time, and documented in the patient's records, "is important evidence of the appropriateness of therapy," say the guidelines, written as a series of questions-and-answers for doctors to keep on file.

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