The Negative Impact of Narcotic Regulations on Long Term Care Patients

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A family sits by their loved one in the last hours of his life, supporting him in his time of need. He has resided in a long-term care facility for the past two years. As his organs slowly shut down, his body succumbs to immense pain. He is sweaty, his brow is furrowed, and each time he is touched to be cared for he moans. The morphine doses prescribed to handle his pain are no longer effective.

In order to provide this patient with the best care possible, his nurse tries to contact the physician. It is the weekend and the nurse is only able to page the on-call doctor. She anxiously awaits a return phone call, while explaining this situation to his distressed family. The pain appears to be increasing. Twenty minutes later the physician calls her, and issues orders to increase the morphine doses. The nurse then contacts the pharmacy answering service and waits for the on-call pharmacist to return a call. In twenty more minutes the on-call pharmacist responds and informs the nurse that he needs to directly speak with the physician before she can legally give the medication and that he will contact her after this has occurred. In the interim, the patient dies in immense pain and the family is distraught that his last hour was spent in agony.

This situation is playing out time and time again in long-term care facilities all over the United States as a result of regulation DEA-337N that was reinterpreted by the Drug Enforcement Agency (DEA) in January, 2010. The regulation states that a nurse has to be an agent of the prescribing physician to call in a narcotics prescription to a pharmacy (U.S. Department of Justice, 2010). In theory, this new regulation makes sense to prevent illegal acquisition of narcotics, but it is potential...

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...dents, DEA-337N requires immediate revision. Patients in the long-term care setting can experience inordinate amounts of pain while waiting for physicians to arrange the dispensing of narcotic medications necessary for pain control.


United States Department of Justice, Drug Enforcement Administration. (2010). Title 21 code of federal regulations Washington, DC: Government Printing Office. Retrieved from

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Yukari, T, Noriko, M., & Okamoto, Y. (2010). Literature review of pain prevalence among older residents of nursing homes. Pain Management Nursing, 4(11), Retrieved from
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