Pain management and the U.S. Department of Justice

The Drug Enforcement Agency (DEA) may be restricting the ability of RNs and LPNs in assisted living communities (ALCs) in some states to provide pain relief for residents. The DEAs enforcement of the requirements of the Controlled Substances Act (CSA) to reduce diversion of controlled substances (particularly Schedule II meds) for criminal or nefarious reasons, has generated a variety of responses by pharmacies, ALCs, and practitioners. Residents are at risk for--and some residents have already experienced--inadequate pain management. The argument seems to turn on whether an ALC (or nursing home or home health nurse) is an "agent" of the physician. The term "agent" is poorly defined in section 1300 of the CSA. It neither confirms that an ALC/long-term care (LTC) nurse/medical aide may function as an agent of the provider nor does the definition preclude the ALC/LTC nurse/medical aide as the agent of the provider. This article is an alert to ALCs to examine their controlled drug procurement and pain management procedures and is also a call to advocacy by ALC nurses.