Jody P. Garthwaite, BA is Policy Specialist and Communications Coordinator at the Pain & Policy Studies Group, University of Wisconsin Comprehensive Cancer Center.

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Questions

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Evelyn:

What was the genesis of the Pain & Policies Studies Group at the University of Wisconsin?

Jody P. Garthwaite, BA: As a drug regulator for the Wisconsin Controlled Substances Board, David Joranson, MSSW, our group’s director, became very interested in the role of drug regulation in the treatment of pain because opioids are often the most needed medicine for relief of severe pain, and always the most restricted. He co-founded the Wisconsin Cancer Pain Initiative which began studies of regulatory issues; in 1989 he moved to the University of Wisconsin to begin work developing models for the evaluation of federal and state controlled substances policy. He started the Pain & Policy Studies Group (PPSG) in 1996 to pursue development of an international and national policy studies and communications program.

EC: What does it mean that you are a "World Health Organization Collaborating Center"?

JG: WHO collaborating centers are part of a global inter-institutional collaborative network set up by the WHO to support its program at the country, regional, and global levels, as appropriate. In line with the WHO policy and strategy of technical co-operation, Collaborating Centers are selected because their specialized expertise is needed to strengthen country resources for national health development. PPSG has been the WHO Collaborating Center for Policy and Communications in Cancer Care since its inception and has provided policy guidance to organizations throughout the world, and particularly in India and Eastern Europe. Our aim is to assist others to learn how to evaluate and improve the policies that govern patient access to pain medications.

Articles about the PPSG's international work can be found on its website, and its terms of reference as a WHOCC are in our most recent WHO Annual Report, available at http://www.medsch.wisc.edu/painpolicy/publicat/annrepts.htm.

EC: Who runs your group, how many people are involved now, and how do you stay current with what is going on in each of the 50 states in the US, as well as in foreign countries?

JG: The PPSG is part of the University of Wisconsin Comprehensive Cancer Center in the School of Medicine and Public Health. We have a staff of 8 individuals who are highly experienced in policy research and communications. The PPSG policy team stays current with developments in the US through the use of Lexis, states' professional licensing board newsletters, review of many journals, and communication with many organizations and colleagues. Internationally, we monitor and participate in the work of the United Nations, World Health Organization and the International Narcotics Control Board. We also maintain contact with a number of organizations and colleagues around the world who are involved in drug regulation, pain management and palliative care, and we participate in international conferences.

EC: How have the several editions of the PPSG publication Achieving Balance in State Pain Policy: A Progress Report Card, been received by state drug policy makers?

JG: Our first evaluation of state policy, which we call the Evaluation Guide, was published in 2000. A number of legislatures and state medical boards and patient and policy advocacy groups began using it as a road map for changing policy. When we published the second evaluation in 2003, we also issued our first Progress Report Card (PRC) to measure progress from 2000 and to draw attention to the issues. The PRC showed that legislatures and boards had indeed used the document to guide their efforts to improve state pain policies because many state policies had improved. Some regional divisions of the American Cancer Society are using their state's policy grade as a baseline and utilizing our Progress Report Card and Evaluation Guide as a template for policy change. The reception to these policy resources has been very good; we plan to continue this work.

EC: In the Report Card some states received a very low grade (D or D+) and some states were noted to have added more "restrictive provisions". Did this lead to changes in these states?

JG: There was a net positive change in state policies from 2000 to 2003, but clearly some new state policies also contained some restrictions. We won't know what changes occurred since 2003 until the next Evaluation Guide is published in the fall of 2006, but it is our initial impression that more progress will be evident. States are becoming very responsive to these policy change tools and are making policy improvement a priority of their health care or regulatory agenda. Unfortunately, recent policy changes by the Drug Enforcement Administration have been a set-back.

EC: Why do you think a pain clinician should be familiar with your website?

JG: Clinicians should know about the policies and regulations that govern their practice; every state's pain policies are available in full text on the PPSG website at http://www.medsch.wisc.edu/painpolicy/matrix.htm. In addition, clinicians will find other useful resources, such as the code of federal regulations governing controlled substances prescriptions, published articles about the effect of model medical board policies and prescription monitoring programs, a chronology of communications with the DEA, and information about the extent of diversion of pain medications before prescriptions are written, and a summary of state continuing medical education policies regarding pain and palliative care.