s an integral part of day-to-day lobbying on behalf of anesthesiology, ASA remains a leader in pain medicine because of our involvement at all levels of the legislative and regulatory processes. With the growing public and professional interest in the exciting and fast-developing area of pain medicine, there also is no shortage of opportunities and challenges facing legitimate prescribing of controlled substances for pain patients, both in Washington and in the individual states.

For instance, this year before Memorial Day, the Senate Health, Education, Labor and Pensions (HELP) Committee favorably voted to report a complete Committee Substitute to S. 518, the “National All Schedules Prescription Electronic Reporting Act of 2005,” or NASPER. This long-anticipated event was no fluke in the life of an important legislative measure, and ASA played a crucial role in this positive development.

As background, late last year in the last Congress, a similar measure passed the House of Representatives, but the bill needed refinement in a number of spots — specifically the definitions and provisions needed to reflect the realities of practicing physicians. In addition last year’s bill was tipped too much toward being a law enforcement bill — as opposed to a clinically oriented bill as favored by ASA, that would allow pharmacists and other legal dispensers to confidentially work through new and existing state mechanisms to inform prescribing physicians of patients seeking to fill multiple prescriptions for controlled substances from different sources at the same time.

This Congress the successor bill, S. 518, was introduced in the Senate by its chief sponsors, Senators Jeff Sessions (R-AL), Richard J. Durbin (D-IL) and others. In the House, a very similar bill, H.R. 1132, was sponsored by Representatives Edward Whitfield (R-KY) and Frank Pallone (D-NJ). Even before these bills were dropped into their respective House and Senate hoppers, however, ASA was intimately involved in shaping them, and our lobbying did not stop after their introduction. In fact, while this year’s NASPER bills were greatly improved from last year, ASA’s work had just begun.

Prior to this year’s introduction, ASA worked closely with the House and Senate to ensure that state scope-of-practice laws were not changed by the bills’ language. Early versions of the measures this year could have upset the delicate balance of state laws in this area, possibly allowing greater prescribing rights by nonphysicians of controlled substances. Working in a coalition with the American Medical Association (AMA) and the Pain Care Coalition, ASA also held back language that would have given law enforcement new authority to launch “fishing expeditions” against physicians, with a chilling effect on legitimate pain prescribing. Both of these important changes were made in S. 518 and H.R. 1132, as introduced. Yet even after the Senate bill was introduced and these problems were fixed, further changes at the Senate committee level threatened to make the bill unacceptable to anesthesiology.

In the week before the HELP Committee mark-up alone, there were at least four different versions of changes in the crucial “drug diversion” portion of the bill, along with many other critical wording changes throughout, several of which would have caused ASA to withhold its support if we had not been able to change them to meet our acceptance. At stake in this high-stakes lobbying exercise was the central premise of the bill that any state drug monitoring program for controlled substances needs to be developed in close consultation with physicians.

As ASA has explained repeatedly in its direct lobbying contacts, these drug monitoring bills were not written to make such programs a mere tool of law enforcement to launch heavy-handed investigations, but instead they were proposed to solve abuse and diversion problems first through the strength of the physician-patient relationship.

Throughout this process, ASA stuck to its policy and principles on these central issues and prevented any new authority being added to the bill that would have made it easier for law enforcement to override the measured drug monitoring programs that have proved so successful in many states to date. To this end, ASA withheld a formal letter of support for the Senate bill until it was absolutely sure that the final legislation moving through the Senate HELP Committee met its policy goals. The important lesson here is that an organization’s support must be carefully leveraged against the power it holds to get needed changes in any bill while still encouraging its movement forward.

The favorable HELP Committee vote on a perfected S. 518 is a testament to bipartisan cooperation and the new leadership of Chairman Michael B. Enzi (R-WY), working hand-in-hand with interested stakeholders such as ASA. Much credit also is due to the hard work of Senators Sessions and Edward M. Kennedy (D-MA) and their dedicated staffs. The legislative history of S. 518 is already a textbook example of a highly effective organization, our ASA, timing its full support for a bill to coincide with its mark-up in an perected form.

This victory in achieving our ASA policy goals on S. 518, as reported from the HELP Committee, moves us forward and builds on ASA’s continuing efforts, through 2004 and into 2005, with the Drug Enforcement Administration (DEA). As many will recall, despite marked progress in early 2004, DEA published a notice in the Federal Register last year that justifiably alarmed many pain physicians. In short it appeared that DEA was changing course and would start to investigate any physician writing sequential prescriptions for controlled substances for any patient.

Springing into action earlier this year, ASA jointly pursued a high-level meeting, along with AMA, to speak directly with the DEA Administrator and learn why that agency appeared to have taken such a big step backward last November on legitimate pain prescribing. In our subsequent exchange with DEA Administrator Karen Tandy, ASA made tremendous progress in educating DEA officials about the nature of existing state law requirements and how they impact good patient care in the prescribing of controlled substances.

Based on this meeting and subsequent public statements by DEA, it is now clear that physicians involved in the legitimate prescribing of pain medications are not the target of DEA enforcement actions. Again, ASA deserves tremendous credit for working through these issues at the highest levels of our federal government.

Timothy R. Deer, M.D., is President and CEO, The Center for Pain Relief, and Clinical Professor, West Virginia University, Charleston, West Virginia.

Ronald Szabat, J.D., LL.M., is ASA Director of Governmental Affairs and General Counsel.