The ammunition industry group, SAAMI, sets chamber pressure standards for cartridges and usually goes very much to the safety side of the equation. For example, the .38 Special cartridge is over 100 years old, and certain firearms which were chambered for it in 1900 might not be able to handle the pressures that a more modern firearm might (better metallurgy, for example). In the case of a few cartridges like the .38 Special and 9mm Parabellum, they set additional standards for those firearms which are SPECIFICALLY designated by their manufacturers to fire +P ammunition. These firearms are usually marked +P on barrels or frames and are also so noted in the manual that comes with them. One should only fire +P ammunition in those firearms specifically designated for it by the manufacturer.
As far as I currently know, +P+ ammunition is supposedly only available to law enforcement and the military, but I could be wrong.