On January 2, 2012, doctors in Washington became subject to new rules regarding prescription of widely-used pain medication. These rules affect treatment of patients with chronic pain not associated with cancer or end-of-life pain control.
Citing a 395% increase in unintentional poisoning from prescription pain medication between 1995 and 2009, the Washington state legislature passed a law in 2010 (ESHB 2876) requiring five different medical boards to create new rules for prescription of opioid medication. The rules are intended to improve patient safety and provide doctors with guidelines for prescription of these powerful drugs.
The regulatory boards for seven types of practitioners developed rules for prescription of pain medication. The practitioners covered by the new rules include physicians and physician assistants, osteopaths and osteopathic physician assistants, advanced registered nurse practitioners, dentists, and podiatrists.
The new rules apply to drugs known as opioid analgesics. Opioids are a class of drugs that affect specific pain receptors in the brain. Natural opioids are derived from a specific alkaloid in the opium poppy. There are now many synthetic opioids as well. Common drugs within this class, and covered by the new rules, include methadone, morphine, codeine, hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), fentanyl and many others.
The new rules do not apply to prescriptions for acute pain, such as a new injury, or for post-surgical pain. They are intended to provide guidelines for treating patients who have chronic pain, defined as pain lasting over three months and not related to treatment for cancer or hospice care.
Physicians will be required to keep thorough records of a patient’s history, potential for drug abuse, and the need for opioid medication. In certain circumstances, such as dosage over a set limit, doctors are required to consult a pain management specialist in one of several ways. Criteria for exemption from the consultation rule and for qualification as a pain management specialist are also set out.
While the new rules are intended to reduce the incidence of prescription drug abuse and death associated with these drugs, the real effects of the regulations will only be known with time. Treatment of pain is an important part of the practice of medicine. However, the potential for abuse of prescription medication makes some doctors are wary of prescribing these drugs. Some doctors are relieved to have guidelines to follow. Some doctors find the requirements daunting and intend to simply refuse to treat chronic pain patients and require them to obtain prescriptions from a pain management specialist. There is concern that this will result in some patients being unable to obtain necessary prescriptions either as a result of the availability of specialists in their area or lack of insurance coverage for such specialists.
For some, the inability to access necessary medication may result in reduced functionality, poor quality of life and unnecessary suffering. For others, the new rules may provide enough of a barrier to avoid dependence and addiction. As with any new law, time will tell.