Washington State Opioid Rules Article

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Ligament

Interventional Pain Management
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I'd suggest you guys read this, your state legislature may try to impose these rules on your physicians as well. The rules are so stupid. Neurologist, Rheumatologists, Anesthesiologists, and Physiatrists are considered pain management "experts." Thus, a pediatric neurologist could consult on any patient on high dose opioids. A cardiac anesthesiologist who has not treated chronic outpatient pain in his career can opine whether your patient's fentora prescription is appropriate. What a mess.

http://seattletimes.nwsource.com/html/localnews/2016035307_pain28m.html

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With all respect to the doc in the video his analogy in confusing. If practicing pain docs don't get it he must get a lot of deer in the headlights from pts. After listing the tx's offered to pain as a 'noun', he later lists the exact same tx's for pain a 'verb' after claiming a major paradigm shift.
 
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I don't see why pain can't have a multitude of grammatical uses... it can be like "frack".

"Pain" does have a verb usage that is proper, such as "It pains me to tell you I'm discharging you as a patient. No, actually, that makes me gleeful".

Another is "My leg has been painin' me for a while; it hurts somethin' awful". Now, if your name is in reference to baseball, it's less likely you'd have heard this. The other indefinite is "a while", in that the patients frequently cannot clarify as to that is hours, days, weeks, months, or even years.

Counter this with the elderly lady saying she is bleeding "down there", but can't/won't be more specific, except to increase the level of stridency each time. "Down THERE! DOWN THERE! DOWN THERE!"
 
"Pain" does have a verb usage that is proper, such as "It pains me to tell you I'm discharging you as a patient. No, actually, that makes me gleeful".

Another is "My leg has been painin' me for a while; it hurts somethin' awful". Now, if your name is in reference to baseball, it's less likely you'd have heard this. The other indefinite is "a while", in that the patients frequently cannot clarify as to that is hours, days, weeks, months, or even years.

Counter this with the elderly lady saying she is bleeding "down there", but can't/won't be more specific, except to increase the level of stridency each time. "Down THERE! DOWN THERE! DOWN THERE!"

[YOUTUBE]http://www.youtube.com/watch?v=AyZfX9tBW3g[/YOUTUBE]
 
For years, I believed the most inane, illogical, and ill-considered laws were created in Washington DC. I was wrong. Clearly Washington State has that dubious honor. It appears of all states in the union, Washington state has turned EBM on its head, and is adopting whacko regulations that will cause untold amount of harm to its own citizens. At least the rest of the US will be able to use Washington State as an example of how perverse and harmful legislative action can be when both science and compassion are jettisoned for the sake of saving money.
 
For years, I believed the most inane, illogical, and ill-considered laws were created in Washington DC. I was wrong. Clearly Washington State has that dubious honor. It appears of all states in the union, Washington state has turned EBM on its head, and is adopting whacko regulations that will cause untold amount of harm to its own citizens. At least the rest of the US will be able to use Washington State as an example of how perverse and harmful legislative action can be when both science and compassion are jettisoned for the sake of saving money.

That is the only reason. Wait until the ACOs start whacking away at pain. Or the state exchanges.
 
Ok, the Washington State opioid laws have gone into effect and now we get to see what happens. I'll tell you what is going on. The PCPs are not consulting pain doctors regarding the appropriate use of opioids in their patients. Rather, they are, EN MASSE, discharging patients outright, with no referral, no opioid taper plan, no addictionology referral, nothing. Just kicking them out of the practice. Their all too convenient reasoning? "The state says we CANNOT write opioids any more."

Thats right, look how wonderful the plans of bureaucrats have worked out once again....

And you know what? I'm betting this is what the legislators wanted to happen. They don't care that patients are on APPROPRIATE opioids. They want EVERYBODY off opioids.

**** you, Washington State.
 
On the plus side, the PCPs will probaly stop giving vicodin Rxs for hangnails and splinters.
 
Where will they all go? Oregon and Idaho?
 
I'd suggest you guys read this, your state legislature may try to impose these rules on your physicians as well. The rules are so stupid. Neurologist, Rheumatologists, Anesthesiologists, and Physiatrists are considered pain management "experts." Thus, a pediatric neurologist could consult on any patient on high dose opioids. A cardiac anesthesiologist who has not treated chronic outpatient pain in his career can opine whether your patient's fentora prescription is appropriate. What a mess.

http://seattletimes.nwsource.com/html/localnews/2016035307_pain28m.html

If you were to limit pain management experts to fellowship trained MDs/DOs then I think you'd run into problems with access. Moreover, many of the 'experts' on this particular forum are unwilling to see 'opioid' patients.
 
If you were to limit pain management experts to fellowship trained MDs/DOs then I think you'd run into problems with access. Moreover, many of the 'experts' on this particular forum are unwilling to see 'opioid' patients.

Many of us are willing to see opioid pts, and then opine whether the opioids are appropriate, or appropriate dose, frequency, etc. Most are even willing to prescribe for appropriate patients.

The difference of opinion mostly lies in the definitions of who is appropriate for opioids. My threshold is very high, and I feel the vast majority of patients can be treated with other meds or methods..
 
Many of us are willing to see opioid pts, and then opine whether the opioids are appropriate, or appropriate dose, frequency, etc. Most are even willing to prescribe for appropriate patients.

The difference of opinion mostly lies in the definitions of who is appropriate for opioids. My threshold is very high, and I feel the vast majority of patients can be treated with other meds or methods..

You mean going down the street to the other guy willing to Rx almost anything to anyone?

If I say no, I lose that patient to follow-up. Wouldn't it be nice to know what happens at 6,12, and 36 months?
 
many of us are willing to see opioid pts, and then opine whether the opioids are appropriate, or appropriate dose, frequency, etc. Most are even willing to prescribe for appropriate patients.

The difference of opinion mostly lies in the definitions of who is appropriate for opioids. My threshold is very high, and i feel the vast majority of patients can be treated with other meds or methods..

1+
 
I don't disagree with the last two posters. I think the WA legislation could be better written. For example, the 'experts' proposed could be better defined/refined in order to ensure access for patients. Moreover, there
should be explicit recommendations for continued participation by the primary care provider once the 'expert' has been engaged, ie, no dumping. The
rules could even go so far as to recommend a pain consultation for treatment
recommendations and then f/u with the primary provider for refills with
2-4x/yr review by the pain management expert. (Trilateral contract)

The data from which the dosage guidelines were drawn are from Von Korff. He showed a 9 fold increase in adverse events when the daily dose exceeded 100mg/day.

1. Opioid prescriptions for chronic pain and overdose: a cohort study.
Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, Weisner CM, Silverberg MJ, Campbell CI, Psaty BM, Von Korff M.
Ann Intern Med. 2010 Jan 19;152(2):85-92.
 
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