The concept of addiction in law and regulatory policy related to pain management: a critical review.
OBJECTIVE
To present a critical appraisal of the present definitions of addiction-related terminology that appear in US laws and regulatory policies that apply to the prescription of controlled substances for pain management.


METHODS
To establish an appropriate context for existing policy definitions, a historical review was conducted of reports from the World Health Organization expert committees on addiction-related concepts, beginning in 1950. In addition, current World Health Organization and American Psychiatric Association diagnostic classification nomenclature were examined. Results from recent criteria-based evaluations of federal and state laws and regulatory policies containing addiction-related terminology also were referenced.


RESULTS
Numerous examples are provided to clarify how inaccurate understandings of the nature of addiction, which can be corroborated by archaic definitions in some states' laws, can impact treatment decisions and patient care. Finally, this article discusses terminological and treatment implications of such concepts as "risk mitigation" and "responsible prescribing", which are goals currently emphasized in the pain management field as principal means to reduce addiction to or abuse of prescription opioid medications.


CONCLUSIONS
Although notable improvement has been achieved, policy content in some states has not kept pace with advancements in medical and scientific knowledge about the interface between pain management and addictive disease. Effective translation of addiction-related concepts into clinical practice remains an important objective for promoting public health related to treating pain and reducing non-medical use of opioids.
Gilson
Aaron M
AM
Pain and Policy Studies Group, University of Wisconsin School of Medicine and Public Health, 406 Science Drive, Madison, WI 53711, USA. amgilson@wisc.edu
D003416:Criminal Law / Q000331:legislation & jurisprudence; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence*; D035082:Federal Government; D006291:Health Policy / Q000331:legislation & jurisprudence; D049673:History, 20th Century; D006801:Humans; D009293:Opioid-Related Disorders / Q000145:classification* / Q000175:diagnosis* / Q000266:history; D059408:Pain Management; D010147:Pain Measurement; D009626:Terminology as Topic; D014481:United States; D014944:World Health Organization