New Washington law limits access to opioids

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Washington lawmakers have taken new steps to limit access to prescription opioids, such as OxyContin.

Despite opposition, Washington state lawmakers have passed HB 2876, a bill which will restructure the way in which opioid pain medications are prescribed in the state.  Lawmakers cite increasing deaths due to prescription drug overdose as the catalyst for their action.  Washington State Department of Health reports that  from 2003 to 2008, the deaths from prescription medication overdose rose 90%, resulting in approximately 500 deaths in 2008 alone.  HB 2876 repeals the State’s current guidelines on pain management and replaces them will new rules for chronic pain management including dosing guidelines, indications for consultation with a pain specialist, and requirements for outcomes and opioid use tracking.  These new rules will apply only to chronic pain, and not pain resulting from acute injury or malignancy.   The Agency Medical Directors’ Group, the Department of Health, the University of Washington,  and the Washington State Medical Association will collaborate to develop the guidelines.   Several  public hearings will be held over the summer and early fall to discuss the elements of the proposed guidelines.

The bill passed despite intense opposition from local and national groups, including the Washington State Medical Association, American Society for Pain Management Nursing, American Academy of Pain Management, and American Pain Foundation.

The new law may limit access to medications necessary for adequate pain control.

Each has expressed concern about the potential for guidelines to result in decreased access to adequate pain control.  The groups are asking their membership to attend the hearings and advocate for guidelines that will minimize care access restrictions.   They cite the relative paucity of pain specialists, particularly in small and/or remote communities.  Like these groups, we urge clinicians and patients, particularly those in rural communities, to attend these meetings to ensure patients with chronic pain continue to have access to pain care.

For more information, please see:  www.doh.wa.gov/hsqa/professions/painmanagement/FAQ.htm

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10 Responses to “New Washington law limits access to opioids”

  1. christinefernan Says:

    This is a very interesting topic. The potential risk of overdose and abuse from pain killers are real and dangerous, yet clinicians want to reserve their ability to prescribe medicines to patients who need them. I believe the issue with potent medications such as these and psychotropic drugs are that once they are prescribed, there is insufficient ongoing contact and management of the patient. In addition, often times, patients can be taking prescription drugs from other physicians for other conditions. Pain management guidelines is a start. Also, the consideration of a pharmacist consultant for ongoing evaluation of the complete set of drugs the patient is taking is a comprehensive approach to addressing the overdose issue.

  2. ag002f Says:

    The increasing number of deaths due to prescription drug abuse has led numerous states to consider legislation this session in an attempt to address the problem. Many states considered implementing prescription drug monitoring programs – an electronic database that collects designated data on substances dispensed in the states. However, states such as Washington and Florida took a different approach, which as you mentioned has the potential to limit patient access to care.

    In Florida, the Governor approved S. 2272 on June 4, 2010. The law requires that pain-management clinics have to register with the Department of Health, but the law also outlines training requirements for physicians. Many groups have raised concerns that the training requirements are too restrictive.

    http://www.tampabay.com/news/health/physicians-meet-to-discuss-sweeping-changes-to-pain-clinic-rules/1110985

    http://www.heraldtribune.com/article/20100607/article/6071058

  3. oharrison0 Says:

    The debate about the control of opiates prescribed for pain relief frequently focuses on the relatively small number of individuals who abuse the medications and on the resulting deaths. What tends to get squeezed out is the “silent majority” of those who use these medications to control moderate to severe pain. The negative health utility of chronic pain is often underestimated by healthcare workers and policy-makers. In practice strong opiate medications tend to be used rather sparingly by physicians, especially in the outpatient setting. It would be informative for this debate to see a balanced objective estimate of the societal burden caused by moderate to severe pain (amenable to control by opiates) and the burden caused by opiate abuse and premature deaths (with the burden of each measured using a common metric, ideally QALYs). This objective measurement would help inform the broader policy debate.

  4. jcapricious Says:

    This is a very interesting article. Although I see the health benefits of opiods and can agree with the previous poster on the role of the “silent majority”, because of their addictive nature, I definitely agree that there has to be some type of restriction and health guidelines set into play. Addicts may go to different doctors and clinics ton get prescriptions but do you believe that those individuals with “moderate to severe pain” may have a slight addiction as well?

    Chronic pain is horrible but the fact that people are dying in an attempt to mask the pain with prescription medication, in my opinion, is a more severe issue. Life shouldn’t be lost in an attempt feel better. The new restrictions of “dosing guidelines, indications for consultation with a pain specialist, and requirements for outcomes and opioid use tracking” seem to be a very good start. I agree with Christine F. that a more comprehensive approach needs to be taken and pharmacist consultations and ongoing evaluations are definitely a needed next step.

    Also, do you think there should be more research set to alternative means of handling the pain? Medications seem to just cover up the issue instead of truly attempting to ameliorate what is wrong.

  5. Dave Auerbach Says:

    Sadly, once again the legislature has hurt those in need of protection. Clearly the intent of the passed legislation is to help reduce the volume of opiates available for illicit use. I strongly support anything that will reasonably achieve that goal. I do not think that this legislation does that. While it would certainly result in some decrease in the amount of drugs prescribed the vast majority of people affected would be those legitimately needed pain relief. Worse, the legislation codifies dosing guideline. It is hard to think of things that change quicker than medical recommendations or that change slower than laws.

  6. rchard22 Says:

    I actually first agreed with this policy. However, as I read more I began to ask more concerning questions? How effective are clinical guidelines in preventing abuse/misuse/diversion? (The prior set of guidelines was uses by the minority of physicians.) Is the law the appropriate place to make treatment recommendations? Do mandated guidelines allow for the flexibilty needed to treat a diverse population? Who will be making the guidelines? What are their qualifications? Will the guidelines be evidence-based or expert opinion? I found that I was dissatified by the answers to these questions.

    With regard to alternative tx, there are lots of great options: acupuncture, massage, pain psychology (biofeedback, coping skills, etc), physical therapy. Sadly, it is really hard to get them paid for.

  7. eshouldice Says:

    @rchard22, I had much the same reaction. As someone who sees a lot of opiate misuse and diversion (or attempted diversion) in clinical practice, I thought this was a good legislation, but in reading further, I’m not sure that all of the potential issues have been addressed. Are people who currently have access to pharmaceuticals through subsidies going to have comparable access to alternative treatment. What sort of training is going to be available for health care providers? I think the intention of the legislation is good, but the intervention/policy needs to be thought out a bit more.

  8. public good Says:

    I agree with rchard22 and eshouldice. As a clinician, I sometimes feels stuck between competing regulatory movements on pain management: those that encourage pain to be treated and those that restrict the use of opiates. On the one hand, the Joint Commission mandates that a physician document inquiries about pain at every visit. It is a bizarre regulation, enforced at the institutional level rather than the individual practitioner level, but it creates an expectation that pain be managed by all physicians all the time. On the other hand, legislation like this, among other disjointed regulatory efforts, tries to help by creating a universal protocol, which does not quite fit every patient. As mentioned in other comments, good pain management requires not only medical therapy but multi-modal therapy, along physical and psychological axes, and it would help if regulatory bodies worked to make more treatment options available to medical professionals, rather than fewer.

  9. ccma rules Says:

    ccma rules…

    […]New Washington law limits access to opioids « SBFPHC Policy Advocacy[…]…

  10. Vinny Rod Says:

    is there a civil suit started?

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