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Regulating Pain Clinics

posted on Wed, Feb 15 2017 3:50 pm by The Network

The Network was recently contacted by a requester who asked for information about effective state approaches for regulating pain clinics. A pain clinic is a health care facility primarily focused on treating chronic pain, often by prescribing controlled substances including opioids. Pain clinics that frequently provide inappropriately large quantities of prescriptions are often called “pill mills,” and these facilities have been implicated in the proliferation of both prescription opioid and heroin overdose deaths. States have primary responsibility for regulating prescription drug practice and pain clinics.

The Network provided the requester with the following resources outlining and describing different aspects of pain clinic laws:

  • The Centers for Disease Control & Prevention (CDC) has a “Menu of Pain Management Clinic Regulation,” which describes state definitions and strategies for regulating pain clinics. The document is from 2012, but the basic elements have not changed since then.
  • The National Alliance for Model State Drug Laws also has a  compendium of state laws aimed at reducing inappropriate opioid-related pain care. The resource describes a variety of state approaches and details which states employ each approach.


The pain clinic regulatory approaches in two states, Texas and Florida, have been specifically studied for their effects. The review of the Texas law showed it to be related to decreases in opioid prescribing, but health outcomes were not examined. Two studies found similar results after laws regulating pain clinics were implemented in Florida, although the researchers were unable to determine whether the effect was due to pain clinic laws or other interventions that were introduced around the same time.

Similarly, the CDC published a study in 2016 that examined the effect of state policies aimed at reducing inappropriate opioid prescribing. The researchers found that “mandated review of prescription drug monitoring program [PDMP] data combined with pain clinic laws was significantly associated with both decreased amounts of opioids prescribed and with decreased prescription opioid overdose deaths.” Because states that mandated PDMP review adopted the requirement around the same time that they adopted pain clinic laws, however, researchers were unable to determine whether the effects were associated with just one of the laws or with the combination.

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