November 22, 2023


In July of 2023, the Medical Board of California (MBC) issued an update to the 2014 Guidelines for Prescribing Controlled Substances for Pain. In the past several years, the MBC has taken a very hard line with respect to the prescription of controlled substances, including its work on the “death certificate” project. As a result, many healthcare providers, primarily general medicine specialists, declined to accept patients with chronic pain into their practice and numerous pain management clinics closed.

The goal of the new guidelines was to balance the interests of providing chronic pain patients with access to treatment, including medications, against prevention of opioid-related overdoses. Patients were to be treated as individuals with customized treatment plans and physicians were encouraged to use their clinical judgment and decision-making based on the needs of their patients.

Some of the key changes in the new guidelines include:

  • Offering increased screening tools to providers to evaluate patients for mental health disorders and pain assessments;
  • Deemphasis of morphine milligram equivalent (MME) thresholds based on a determination that one size does not fit all. The new guidelines do not include an upper limit on MME thresholds;
  • Emphasis on considering buprenorphine when appropriate as an alternative chronic pain management medication (now approved by FDA for pain management);
  • Recognizing the unique challenges associated with legacy patients, and using a balanced and cautious approach when tapering from long-term, high-dose opioid use;
  • Improved delineation of an optional exit strategy if the healthcare provider determines that opioid medications need to be stopped;
  • Improved and/or maintained quality of life should be documented as part of the rationale for treatment with an emphasis on measuring effective pain relief within a patient’s ability to function in day-to-day life.

The impact of the new guidelines, as well as the MBC’s stance towards physicians treating chronic pain patients, remains relatively unknown at this time. HB remains committed to representing individual physicians facing inquiries from the MBC for issues related to drug prescriptions as well as a wide array of other concerns.

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