Years ago, I attended a course at the University of Oregon that was supposed to address pain management. Instead, it turned into a diatribe on why not to prescribe controlled substances. It included a director from one of their local emergency rooms who flatly said he did not allow any of his staff to prescribe a controlled substance for pain, ever. I found the presentations very unrealistic and frustrating. Maybe Dr. "X"'s ER did not prescribe Tylenol #3 for a broken ankle, but you can rest assured the next ER down the road did, thereby doubling the healthcare costs. What I need are real guidelines for pain management, not blanket lectures against their use. I did not find the REMS course helpful. All I got out of it was to be extra careful with methadone due to its long half life, and don't start opiate naive patients on long acting opiates.
