Doctors say rules for pain meds are scaring them into abandoning patients
New state rules for prescribing pain medication are so strict they are scaring some doctors into abandoning their patients and avoiding treatment of pain, patients and doctors told lawmakers in Olympia on Thursday.
Seattle Times health reporter
Tougher state rules for prescribing pain medication — aimed at curbing abuse — are prompting some providers to abandon patients and avoid treating pain, patients and doctors told state lawmakers Thursday.
"A lot of what we are hearing is physicians are afraid to take care of patients or they have concerns about taking care of patients because of the documentation requirements and the examination requirements," said Denny Maher, director of legal affairs for the Washington State Medical Association (WSMA).
The medical association, with support of the Washington Osteopathic Medical Association, has formally asked the state's licensing authorities to amend the rules, which took effect last month. The regulations were written to implement a law passed in 2010 to tighten narcotic pain-medication prescribing after rising deaths.
Among other things, the rules require doctors prescribing pain medication to conduct detailed examinations and documentation of patients' pain and function changes, and to consult pain specialists if they are prescribing high doses for a patient.
The medical association, Maher said, wants the regulations changed so they only apply to patients using large doses or who have serious pain problems. That would also make the regulations more tightly focused on the patients who need help the most, he said.
But most important, Maher said, doctors want the word "shall" in the law changed to "should." "Shall" creates a legal mandate, he said, making doctors fear legal problems or disciplinary action if they don't follow the detailed rules exactly.
"I think that has spooked a lot of physicians to where they are no longer willing to write prescriptions for these conditions," WSMA President Dr. Douglas Myers told lawmakers.
Two patients told the committee members how they or family members had been abruptly cut off by doctors and clinics and how they've struggled to find providers willing to prescribe pain medication.
Bert Goeller, of Tacoma, said he often suffers excruciating nerve pain from multiple sclerosis, and must now drive an hour each way to see a pain-management specialist.
Dr. Alex Cahana, chief of the University of Washington's Division of Pain Medicine, detailed for the committee how the UW has beefed up the number of pain specialists there, drastically cut the time patients wait to be seen, and provided doctors with educational materials, including a weekly educational "telepain" series and Web-based consultation.
Dr. Jeff Thompson, chief medical officer of the state's Medicaid program, said many primary-care doctors need help understanding the rules, along with more information on how to help patients on high doses to taper their use.
He said he has personally talked to doctors in some of the counties with significant pain-medication problems, including Clallam, Snohomish and Spokane.
"They're scared, and they need some help, and they need some tools," he told the lawmakers, "and that's really what we're doing here."
Thompson said he has also talked to 20 prescribers of pain medication who are responsible for 70 percent of Medicaid patients now taking high doses of narcotics. They're supportive of the state's efforts, he said. But like the others, they need more assistance to work effectively with their patients.
Thompson praised the statewide Prescription Monitoring Program that tracks narcotic prescribing, as well as the efforts of the state Department of Health, the UW, and emergency doctors who put forth rules for emergency-room handling of narcotic pain medication.
The rules, Thompson said, are an excellent first step, but more needs to be done.
"It's going to be very painful over the next two to five years," he said, "because we've created a situation where there's fear — fear in the client's heart, fear in the provider's heart, and the system's heart."
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org. On Twitter @costrom.