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Thread: Article about WA State Doctors Dumping Pain Patients

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    Default Article about WA State Doctors Dumping Pain Patients

    Sad article about chronic pain treatment with opiates in my state: http://seattletimes.nwsource.com/htm...7_pain28m.html

    "Over the last several months, an effort in Washington to curb a steep rise in prescription-drug overdose deaths — the most ambitious crackdown in the nation — has prompted a number of doctors and clinics to stop taking new chronic-pain patients on opiates, and in some cases to cut off current pain patients."

    They don't go into details about the new rule, but from what I understand, it will require chronic pain patients to have following by a pain specialist if they are over a certain amount of morphine equivalent. This would have to occur before changing or increasing meds. http://apps.leg.wa.gov/documents/bil.../2876-S.SL.pdf

    My doctor seems very fearful of this. My pain is already very undertreated and its almost getting to the point its not worth being on the meds anymore if they are barely helping and I have to jump through so many hoops and take the risk of being cut off. I think there is a lot of confusion about this law. I keep getting different stories from different sources. I'm all for pain contracts and drug tests if needed, but not this doctor fear that will keep them from treating pain with narcotics in patients who have no other options. So sad. Anyone else here in WA state? Anyone in other states see anything similar going on? Best wishes.
    Kate
    Constant headache for 10 years and other chronic health issues

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    What I have heard is that the limit is 120mg of Morphine/day or equivalent (~80mg of Oxycodone or 25-50 Fentanyl patch).. the only way that a PCP can prescribe more than that...is to be working in conjunction with a pain specialists. I suspect that is going to be nothing short of a disaster and increase the overall expenditures for our healthcare system and do nothing to improve pain management in general.
    Pharmacist Steve
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    Thanks Steve. Agreed. We already have a shortage of pain docs in general. The majority of them are anti-opiates to begin with. It will be hard for these primary docs and such to find someone to refer their patients too, let alone one which will concur with their recommendations. I asked my primary doc about a pain doc referral because I thought I was to that point (and they might be willing to be more aggressive with my treatment), and he had no idea about who to go to. I searched on my own with little success--few in the area, most are back clinics, not taking new patients, etc.

    I did see one who said he would drop my dosage if I saw him because their clinic has a max dose, but he personally didn't seem to be opposed to it and said he'd send a letter to my primary doc recommending we try a Fentanyl patch since thats the one type I haven't tried (we'll see if said letter showed up). He concurred I had tried just about everything and his only suggestions were re-trying a nerve block with imaging guidance and re-trying a different type of chiro (upper cervical specialty). Still hoping my primary doctor will be willing to work with me on a dose increase or med change, but I think I'm lucky to be getting anything at this point.

    The pain doc seemed to think the rule was only for patients with history of abusing the meds and such. I don't see that in the rule. He also wouldn't really answer my question of would he follow me if need be because he thought I didn't fall under the rule as an at-risk patient, although I am well above the quoted dose. I wanted to get in before the Jan. 1 rush because I can see pain docs shutting their doors to new patients wanting following as well as the primary docs stopping their prescribing. But I also don't see in it the morphine dose equivalent, but I have heard that in other articles and from that pain doc. I also wonder what type of enforcement there will be of this. The doctors themselves don't even seem to understand it. Thanks! Best wishes.
    Kate
    Constant headache for 10 years and other chronic health issues

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    I just wanted to offer my support, Tortoisegirl. That's a difficult situation. I wish I knew what you should do.

    I have chronic daily migraines and need much more than 120 mg. morphine per day.

    Low doses of pain meds really didn't do too much for my pain. Better than nothing, but it wasn't till my pain doc titrated my dose up that I found a modicum of relief.

    I hope things work out for you. I know how bad head pain can be.

    Eva

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    Thanks Eva! I also have a daily chronic headpain condition. I did rather well at first on the meds but have become tolerant. Its sad to know that with the right med and dose tweaking I could probably get back in that 50% relief range, yet no one seems to be willing to do it. I'll keep pushing for it. I got a visit next week with the primary doc. Might try other pain docs, but I'm going blind since none of my doctors had recommendations (primary, neuro, or rheumy). Best wishes.
    Kate
    Constant headache for 10 years and other chronic health issues

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    I just wanted to offer my support, Tortoisegirl. That's a difficult situation. I wish I knew what you should do.

    I have chronic daily migraines and need much more than 120 mg. morphine per day.

    Low doses of pain meds really didn't do too much for my pain. Better than nothing, but it wasn't till my pain doc titrated my dose up that I found a modicum of relief.

    I hope things work out for you. I know how bad head pain can be.

    Eva

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    Distinguished Community Member Pharmacist.steve's Avatar
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    Here is a point... if someone in the state of Washington is being treated with more than 120 mg Morphine or equivalent before the target date of the new law.. If the law does not grandfather those patients.. then the legislature is practicing medicine without a license. There has got to be a constitutional challenge
    Pharmacist Steve
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    Tortoise girl, sorry you are faced with this. I think most of us are under medicated because we would like to not be taking any meds. These laws make you wonder if it is a good choice to be under medicated but we have to live the way we want. I hope the law doesn't cause you much trouble.

    Sorry to hear the state of Washington is treating a serious problem the wrong way. I have to wonder how long these politicians can keep making this kind of mistake. When did we get to the point that we punish everyone to not solve the problem because the abusers will find another source.
    1979 spinal issues, 1993 lumbar microdisectomy L3-4, 1996 360 3 level lumbar fusion L2-5, 1999 open thoractomy fusion T8-9,
    2002 C3-7 herniations and T4-7 herniations, 2004 total disability, a new limited life

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    Hi, I know everyone is different, however in my case I have been taking methadone for years, and generic percoset, called oxycodone. I took the 5 mg, 500, up to 10 a day as needed then years later switched to 15 mg pure oxycodone without Tylenol, and took two at a time up to every 4 hours up to 15 times a day once in a while, but it was like eating baking soda pills, absolutely nothing, in pain relief. I told my dr. and he switched me to 10mg 325 tylonol, & I do get some relief from it. I know people who haven't been taking these meds near as long as I might get some help from the pure oxy but just wonder if it wouldn't be better to try the mix with tylonol or asprin first?? I wonder about prescribing pure oxycodone without tylonol or asprin, and why to do this unless other avenues have been exhausted?? best wishes, ray

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    I don't seem to get any more relief when adding Tylenol, Ibuprofen, etc. Back in the day I was on Percocet but when I needed to go up in dose we took out the added Tylenol. Doctor and I are happier that way as some weeks I do take quite a bit so why have the added med with the risk of liver problems (which opiates don't have) if it doesn't help. It does vary person to person though. For some reason Codeine was always a wonder drug for me. I got way more relief from that than triple the equivalent Percocet or whatever. I thought due to that Morphine would work well, but no (never even got up to a working dose before it was scary high).

    Doctor wouldn't up or change my meds today. :( I guess we're at another standstill. Can't find any pain doctors in my area who will be of help. Have asked all my doctors. Maybe I'll have to start snooping online to see if anyone knows of a pain doc in WA who is not an opiophobe. If they had other ideas for me that would be great, but no one does! Feeling pretty down with that and that the Botox (for headache) didn't work. Best wishes.
    Kate
    Constant headache for 10 years and other chronic health issues

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