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Washington State Pain Management Law Will Take Effect Soon

Patricia Murphy

Starting in July the state of Washington will begin to implement new regulations for physicians and prescribers who treat their chronic pain patients with opiates. The architects of the law say it's meant to provide patients with better pain care and to prevent increasing overdose deaths. But the change is having an unintended effect on a vulnerable population of chronic pain patients, some of whom have relied on opiates for decades.


Jennifer Passantino's husband lives with chronic pain from end–stage liver disease. The south Tacoma woman is desperate to help get him the opiate medication he needs.

Passantino: "You know when a loved one is in pain, you would consider doing anything. And unfortunately it makes me, a law abiding person, consider buying it someplace else."

For a decade her husband was on a daily dose of 10–15 milligrams of oxycodone. But in March he was cut off because of a new "no opiates" policy at the clinic where he was being treated.

Passantino: "My husband was able to get on a bus, take the bus when he had the oxycodone. So now he's come to a point where he's sitting in a chair at home. And this is just not right when he can be functional, he could be functional. He was functional in January and February."

Passantino's husband is one of 2,000 patients at Community Health Care in Tacoma who can no longer get the pain medication they've been prescribed. Critics say the policy at that clinic and others is fallout from an aggressive new pain management law taking effect this year in Washington.

The law is the first of its kind in the nation. It requires all prescribers — like doctors, nurse practitioners and dentists — to keep detailed records about how their patients are fairing while using narcotic pain meds like OxyContin. And in certain circumstances, prescribers are required to consult with a pain specialist.

Sondker: "We live in a society where it's go to the doctor and get a pill."

Russ Sondker is Community Health's spokesperson.

Sondker: "It's the simplest solution and it's often what's done. And we're really trying to get beyond that to where we can look at every patient and say what is best for this individual patient."

Supporters of the law say it's meant to provide patients with better pain care and to prevent an alarming trend of overdose deaths.

The rules don't apply to end–of–life care or acute pain caused by surgery or injury. But those on the other side say the law is already causing a chill across the medical community. Elin Bjorling is with the American Pain foundation.

Bjorling: "One of the things we're fairly concerned about is that it allows for providers to opt out of providing pain care or to opt out of providing opioid therapies."

And that means many patients, especially those on Medicaid, could fall through the cracks. Community Health Clinic says doctors are helping patients taper off their meds. They will still prescribe opiates in cases of cancer or end–of–life care, but Jennifer Passintino says she got no help for her husband's withdrawal symptoms.

Passantino: "I would call and I would ask for a nurse to call us, and our calls weren't returned because they told him that those 25 pills was the last. That was it. There wasn't going to be anymore."

Weeks: "It's unintended and very unfortunate. We don't want people to not get the treatment they need. We just want them to get safe treatment."

Kristi Weeks is director of the offices of legal services for the State Department of Health.

Weeks: "What we're concentrating on right now is the provider population so that we can educate them about the rules and kind of quell some of the panic or the knee jerk reactions that are happening out in the community and really help them understand you can treat these patients. This is not a barrier."

Community Health suggests to its patients that there are ways to deal with pain other than using narcotics — things like physical therapy, yoga, massage or acupuncture. Or over–the–counter pain meds like ibuprofen or Tylenol. But most of these treatments aren't covered by Medicaid because they aren't clinically proven. And Passantino's husband can't take over–the–counter drugs because of the adverse effect on his liver, so she's is looking for a new primary care doctor.

Passantino: "I would say that we've probably called more than 60 doctors and clinics."

So far all have said they're not accepting any new chronic pain patients.

Thompson: "If clients are having difficulty accessing medical services then we want to know about it here at Medicaid /DSHS, and we will do everything in our power to make sure that they get access to the services they need."

Dr. Jeff Thompson is the Chief Medical Officer for Washington State Medicaid.

Thompson: "I think people who have chronic pain do sometimes need narcotics, including long–acting narcotics, and I think what we're trying to say is, what is the dose that will maximize their function and minimize their pain. But when we get up to these extremely high doses I have to look at the numbers and say we have a death every day from a long–acting opiate prescription in Medicaid. There's about 350 deaths per year and that keeps going up and we need to bend that curve down."

Thompson admits the new law makes it difficult for some patients. But in the end it's a matter of providing good care.

Meanwhile, many other states are grappling with the complexities of prescription opiates. They're keeping an eye on Washington to see how the new law plays out.

I'm Patricia Murphy, KUOW News.

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