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Seeking the delicate balance on prescription painkillers

Post by TNT Editorial Board / The News Tribune on Feb. 15, 2012 at 7:52 pm with 1 Comment »
February 15, 2012 5:12 pm

This editorial will appear in tomorrow’s print edition.

When prescribing opiates, the stakes are as high as they come. These powerful drugs can enable pain-ridden patients to work and live normal lives. They can also kill people.

Washington’s health authorities have struggled to come up with rules that would maximize the benefits while minimizing the risks of methadone, oxycodone, Oxycontin, Percocet and similar drugs.

This year has brought a belated new tracking system and an about-face on methadone that both promise to save lives. But it’s also brought a brace of new restrictions that’s been making it harder for some legitimate patients to get painkillers they actually need. Those restrictions may prove themselves in the months ahead, but the jury is out.

The tracking system ­– Prescription Review – connects clinics, prescribers and pharmacists to a database that should make it much easier to spot abuse.

Drug-seekers commonly hop from one doctor to another to get multiple prescriptions they fill at different pharmacies – sometimes to sell on the black market. Most states have a system that flags such abusers and criminals; with Prescription Review, Washington has finally adopted this obvious safeguard. When all else fails, try common sense.

Credit an investigative series by The Seattle Times for the state’s turnabout on methadone. In 2004, the state made methadone the painkiller of choice for Medicaid patients. The drug was cheap and effective.

What it wasn’t, it turns out, was safe. In December, The Times documented a big spike in overdose deaths since 2003 among the poor patients covered by Medicaid.

Overwhelmingly, the chief culprit was methadone. In fact, the state Department of Health itself had picked up that same spike in a study of opiate deaths from 2004 to 2007. Yet the department appears to have continued on autopilot, doggedly sticking by methadone despite contrary evidence.

The state has now changed its tune. It is discouraging methadone. Another victory for common sense.

Still in question are new regulations that require prescribers to keep more records and do more consultations when prescribing opiates beyond a certain daily dosage. The concept is good, but doctors say the details are complicating their practices and increasing their professional risks.

Numerous reports suggest that many providers are dropping their pain patients as a result.

The test of these rules is whether they help sort out pill-poppers from patients who use opiates strictly to control pain that might otherwise cripple them.

Overdoses are common among abusers and patients who are poorly supervised, but rare among those under the care of responsible and competent physicians. The latter should not be sacrificed in the state’s effort to get the rules right.

Leave a comment Comments → 1
  1. tonya1968 says:

    There were 5500 methadone related deaths in 2007.Methadone is a synthetic opiate that is used to treat pain and addiction for heroin and other opiates. When methadone is used for pain, doctors write the patient a prescription for various amounts (120 pills seem to be most common) When methadone is used for addiction patient must go to a clinic to receive dose of methadone until they earn take home privileges. Methadone represented less than 5% of prescribed opiates but was attributed to 1/3 of all opiate related deaths. A dose that is therapeutic for one person may be lethal to another person. Methadone’s’ unique properties make it unforgiving and sometimes lethal.
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