U. S. Department of Justice
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
Suite 232
Fairfax, Virginia 22031-5216

Dear Dr. Heit:

This is in response to your letter regarding pain management and narcotic addiction treatment.

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 judgement for a legitimate medical purpose in accordance with generally acceptable medical standards.

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.

Although pain 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 treatment program.

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.

Sincerely, -

Patricia M. Good, Chief
Liaison and Policy Section
Office of Diversion Control

Enclosure

cc: DPM Kathy Daniels, DPM
Mary Johnson-Rochee, G/S

House of Delegates of the Federation of State Medical Boards: Model Guidelines for the Use of Controlled Substances for the Treatment of Pain

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