The state’s new, tougher stance on opioid prescribing, although initially unpopular, now has many doctors and health officials hailing a better and safer system. The concerns that pain patients would be left in a world of hurt went unrealized, health officials say.
But one local legislator claims the state was guilty of overkill when it adopted the new pain-management rules. And Rep. Paul Harris, R-Vancouver, plans to take his skepticism, and a few ideas of his own, to Olympia this year.
Standing by the rules
In 2010, Washington lawmakers approved a bill, sponsored by state Rep. Jim Moeller, D-Vancouver, calling for new rules concerning the management of chronic pain not caused by cancer. The purpose of the legislation was to improve opioid prescribing and rein in prescription drug abuse and misuse.
The rules require for each patient an evaluation and complete history of pain treatment, a written treatment plan and a written agreement for treatment. The rules also require prescribers of long-acting opioids or methadone to have completed at least four hours of specialized training.
In addition, the rules require, for the first time, consultations with pain specialists for patients who reach an established threshold (120 mg of a morphine equivalent per day) of pain medication.
The rules went into effect for physicians and physician assistants on Jan. 2, 2012, and for all other fields on July 1, 2011.
One of the biggest fears expressed by providers, patients and pain advocates revolved around the consultation requirement. Many worried the state’s pain specialists would be overwhelmed and unable to handle the larger caseload created by the rules.
But the rules allow for consultation exemptions for providers who complete extra education or cannot get their patients an appointment with specialists. That’s why the specialist consultation fears went unrealized, said James McLaughlin, attorney for the state’s Medical Quality Assurance Commission.
“I think that was sort of a bigger issue early on, a panic about a bottleneck of pain specialists,” McLaughlin said. “Once people learned the rules, they learned the panic was overstated.”
The same has proven true for other concerns, said Dr. Mimi Pattison, chairwoman of the medical commission and a member of the state group that crafted the prescribing rules.
“In general, I would say it has been a 180-degree turn in attitude from a year ago,” Pattison said.
A year ago, physicians were afraid of the rules, she said. Many hadn’t read the rules or didn’t understand them. Instead, they reacted to hearsay, Pattison said.
“Once physicians have been educated, probably the most common response we’ve gotten … is thank you,” she said.
In the last year, the commission has not received a single complaint about physicians not prescribing enough opioids, Pattison said. The commission has received inquiries about the rules from patients whose physicians have reduced their pain medications but no formal complaints have been filed, she said.