The purpose of this thesis was to explore the literature regarding physicians’ prescriptions of opioid analgesics before and after The Joint Commission Pain Standards for 2001. Opioids are a last resort treatment for chronic pain due to their high potential for tolerance, dependency, and misuse. The establishment of The Joint Commission Pain Standards for 2001 was the culmination of several movements to address the underassessment and undertreatment of pain. The Joint Commission Pain Standards for 2001 focused on improving pain assessment, management, and treatment through a systematic approach. The Joint Commission (TJC), formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is the largest accrediting body for healthcare organizations in the United States and affects thousands of medical care facilities and physicians. Although many physicians were hesitant to prescribe opioids due to addiction concerns, opioid prescriptions rose due to pressures to meet the TJC’s accreditation requirements and maintain patient satisfaction. Pain management seemed to improve for a short period before adverse reactions and unintended consequences emerged. Confusing language within the TJC Pain Standards for 2001 and its supplemental materials and misleading information from researchers and pharmaceutical companies led to unnecessary pain measurement, problematic pain treatment algorithms, and excessive opioid analgesic use. As patient safety concerns emerged, the TJC continuously amended the TJC Pain Standards for 2001. They were revised in 2017 as the opioid epidemic became a national public health emergency. The TJC has since called for better evaluation of research validity, more vigilant examination for conflicts of interest, and more detailed instructions on interpreting and implementing future standards. The medical community, pharmaceutical industry, government, and the public need to coordinate future strategies to combat the opioid epidemic.

Thesis Completion




Thesis Chair/Advisor

Ramirez, Bernardo


Bachelor of Science (B.S.)


College of Community Innovation and Education


School of Global Health Management and Informatics

Degree Program

Health Management & Informatics



Access Status

Open Access

Release Date