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Will patients be sacrificed in opiate crackdown?

Post by TNT Editorial Board / The News Tribune on Sep. 5, 2011 at 5:15 pm |
September 2, 2011 3:23 pm

Hydrocodone, the addictive narcotic that is the key ingredient in Vicodin and other medicines, is an often-abused prescription painkiller. (The Associated Press)

This editorial will appear in Tuesday’s print edition.

The state Department of Health is attempting a tough balancing act as it tightens the rules on prescription opiates.

Thousands of Washingtonians who suffer from severe chronic pain depend on these powerful painkillers. Unfortunately, common drug-seekers also hunger for Oxycontin, Vicodin, methadone and the like, and they often get them by conning doctors, buying them on the street or simply stealing them.

Prescribing practices got looser in the 1990s after it became clear that the medical profession wasn’t treating pain aggressively enough. But the loosening went too far, producing a dramatic rise in overdose poisonings.

The 2010 Legislature told the Department of Health to crack down, and the department has adopted new regulations – to take effect in January – designed to prevent abuses.

Many doctors and patients are worried. As of January, physicians who prescribe opiates for chronic, noncancer pain will have to maintain health histories that document a multitude of factors, including their patients’ psychiatric conditions; past addictions; “risk of significant adverse events, including falls or fractures”; and “the effect of the pain on physical and psychological function.”

Such screening is important, but some physicians are chafing over the highly detailed record-keeping and the heightened liability. The regulations tighten dramatically – and include mandatory consultations with pain specialists – when prescriptions exceed set thresholds.

Both the Washington State Medical Association and Washington Academy of Family Physicians have formally complained about “increased administrative burdens.”

The concern is that babies may be thrown out with the bathwater – that doctors and other practitioners will begin to shy away from treating legitimate pain patients. The Seattle Times reported last week that some practices have begun shedding such patients.

The pendulum is swinging dramatically away from over-prescribing opiates. The question is whether it is again swinging too far in the direction of under-treating pain. The Department of Health is making all the right sounds about the importance of opiates in pain-control, but the proof will be in what happens to flesh-and-blood people who need these prescriptions to lead full lives.

The other side of the issue is preventing overdoses and drug abuse. The new rules may well accomplish that, but the most important part of the new regime is a computer database that – come January – will immediately flag “patients” who’ve been prescription-shopping at clinics all over town.

The database should go a long way toward flushing out the drug-seekers from among the pain patients. That may help the latter face a little less suspicion when they ask for needed help.

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