December 1, 2013 – counting today there are fifteen days until Indiana’s Emergency Pain Regulations go into effect. On December 15th the way physicians prescribe pain medications in the Hoosier State will change.

Between now and December 15th I will regularly be posting this pain specialist’s take on the Indiana situation.  Having said that, it is time for a disclaimer:

This is not legal advice. This is not medical advice. I represent no organization. All opinions, unless specifically referenced, are my own. If you have a medical condition please seek advice from your personal physician. Every patient, practitioner, and facility should consult its own counsel for advice and guidance. If you rely upon information from this website, you do so at your own risk.

Here we go…

One should begin this journey by understanding the difference between a law, a regulation, and a guideline.

A law is a rule that has been passed by elected officials. Violation of a law may be viewed as a criminal act.

Indiana’s new pain law (a.k.a. additions to Senate Bill 246) is fairly concise and does not directly apply to physicians. Instead, it says the medical board must come up with regulations – which they did.

A regulation is a rule that is usually created by a government agency (i.e. a “bureaucracy”) as opposed to the legislature. Regulation determines how laws will be enforced. Violation of a regulation may not be a criminal act but can incur a wide-range of penalties.

As previously stated, Indiana’s Emergency Pain Regulations go into effect on December 15, 2013 and are subject to revision until November 1, 2014, at which time the permanent regulations are due.

A guideline, especially when endorsed by a governing body, is a set of opinions that offer insight into the manner in which regulations and laws can be properly followed. Violating a guideline may or may not be considered a wrong move, but generally will require a legitimate explanation as to the decision-making process.

The Indiana State Attorney General’s Office has published a detailed set of guidelines, called “First Do No Harm,” which offer insight as to what regulators will consider as proper medical practice, should they be called upon to investigate a controlled substances related issue.

In summary, Indiana physicians who prescribe controlled substances do not need to know details of the new law, as it does not apply directly to them.

However, physicians should clearly understand the Emergency Pain Regulations and how these regulations will affect their practice after December 15, 2013.

Also, physicians are strongly urged to become familiar with the “First Do No Harm” guidelines and to start incorporating as many of the recommended practices as possible.

Stay tuned.  It’s only December 1st.

There’s more painful truth in the days to come.



    This pain specialist

    The difference between a law, a regulation, and a guideline

    Definition of a “law”

    Indiana’s new pain law

    Definition of a “regulation”

    Indiana’s Emergency Pain Regulations

    Click to access Emergency_Rules_Adopted_10.24.2013.pdf

    Definition of a “guideline”

    The Indiana State Attorney General’s Office

    First Do No Harm (Physician Toolkit)

    Click to access First_Do_No_Harm_V_1_0.pdf

    The Painful Truth

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