Being part of a medical specialty that involves musculoskeletal pain management, I feel there is a need for clarification of the term controlled substance in regards to the law and medical ethics.

As defined by the United States Code (USC) Controlled Substances Act (CSA), a "controlled substance" refers to a drug or substance that has potential for abuse, not to include distilled spirits, wine, malt beverages, or tobacco. Classed within five different groups (I, II, III, IV and V) the misuse of these narcotic analgesics such as opioids or morphine can create health and safety hazards to the patient or to society due to the fact that their effect can appeal to individuals to self prescribe for non-medical-related issues and their demand can promote drug trafficking.

In the eyes of the law, "knowingly offering to sell, selling, purchasing, distributing, or trading a drug, drug sample or even coupon is a criminal act punishable up to 10 years of imprisonment, up to a $250,000 fine, or both." Unfortunately, these offenders have made prescribing medication for pain control a difficult task for physicians due to their acquired ability to deceive, while falsely conveying and representing their level of pain.

Despite the fact that cracking down on drug abuse or addiction is important in today's society, there is an ethical consortium by law enforcement agencies, health care professionals and patient advocates, that it should not interfere with a patient's right to receive deserved and needed treatment, which is where the challenge lies. 

As the physician is placed between an ethical and legal responsibility, determining a patient's need for prescription pain medication must be based objectively on physical examination and diagnostic testing, in addition to the patient's history and reported level of pain. As human nature can sway even the most reliable and honest people, it is ultimately the patient's responsibility to truthfully convey their level of pain to their physician, so that an accurate assessment can be made.

Unfortunately, patients who abuse their prescription pain medication, often enter a vicious cycle. They take their pain medication regularly, even when not needed, as a sleeping aid, for a calming effect, or for a "feeling good" effect. Because these patients end up taking more than the prescribed dose, they learn to mislead and fool even the best of character judges, their friends, and family to get what they need: their pain medication.