Legislation to limit opioid prescriptions under debate

[Yo_Mama_Been_Loggin]

OLYMPIA — State legislators, Attorney General Bob Ferguson and Gov. Jay Inslee are rolling out legislation to limit opioid prescriptions and invest in addiction treatment.

On Jan. 12, the House Committee on Healthcare and Wellness heard public testimony on two bills that would limit the quantity of opioid pain medications that doctors and other providers can prescribe patients who are obtaining opioids for the first time. Patients over the age of 21 could receive no more than a seven-day supply while those under 21 could obtain only a three-day dosage. It also would require that prescribers enroll in a state program to gather data and monitor opioid distribution to prevent over-prescribing.

The former bill also would require that providers notify patients obtaining more than a three-day supply of opioids of the risk of addiction.

The bills are supported by family members of those who have suffered from addiction, as well as law enforcement and public health officials. The bills are opposed by some worried about access to their pain medication as well as lobbyists who were concerned about the burden it would put on doctors.

Both bills were requested by Ferguson, who says they are necessary to prevent patients from becoming addicted and keep excess pills out of medicine cabinets and the hands of non-patients, and to make sure that all providers of opioids participate in the state’s Prescription Monitoring Program, which tracks patient prescription histories.

“The overprescribing of opioids has contributed to this problem which has swept across our state,” said Ferguson. “Despite the attention that this issue has received, overprescribing is still happening.”

Only 35 percent of opioid providers in Washington participate in the voluntary monitoring program, according to Chris Baumgartner, drug systems director at the state Department of Health.

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[Aristus]

1. Oh, the narco addicts aren't going to like this...

Vicious accusations of:

1. You just enjoy inflicting pain!

2. Nothing else works!

3. I'll bet you're not a real doctor/PA/ARNP!

4. I always take them exactly as prescribed! This is unfair!

5. But I really need them!

in 3...2...1...

[Control-Z]

2. Are you being sarcastic?

I can't tell.

[Aristus]

4. Unfortunately not.

It's a daily battle in clinic with people who demand opioid medication no matter how inappropriate a treatment it may be, or how potentially injurious further opioid dosing might be. Or the various reasons why opioids are necessarily contraindicated. (For example, a patient with diagnoses of emphysema and chronic pain should not be prescribed narcotic medications, due to their respiratory depressive effect. A patient with a history of bowel perforation should take opioids, for whatever reason, only for a short period, due to the side effect of severe constipation, etc.)

That's not even mentioning opioid properties such as addiction and tolerance.

Maybe legal restrictions will prevent 18-round battles with addicts. People who dismiss our objections (I'm sorry, prescribing this medication, in this dosage, for this period of time goes against my clinical judgement.) will have to be satisfied with "I'm sorry, state law prevents me from prescribing more than this."

[Control-Z]

8. Sounds like you're in the wrong job if it upsets you this much.

I can only hope you're not working in a pain clinic. Now that would be a pressure cooker for you, wouldn't it?

[Aristus]

9. Every job has elements that even the most fervent devotee of the profession will dislike.

This happens to be mine.

I'm a Physician Assistant working in the community health primary care setting. My major patient population consists of the homeless. It's the most rewarding, fulfilling work I've ever done and I wouldn't trade it for anything.

Treating chronic pain appropriately is more complex than simply writing out a scrip for narcotics. Not every patient is willing to negotiate those complexities with me. They want a quick fix. And it's worth pointing out that the most unpleasantly demanding patients requesting opioids are my mainstream patients, not the homeless ones. Trying to prevent more opioid overdose deaths comes with the territory.

But that doesn't make it any easier.

[RKP5637]

3. So, I wonder how this is supposed to work for people in chronic pain under a dr's care. And,

for example, severe arthritis and rheumatoid arthritis. And those recovering from major surgery.

[Yo_Mama_Been_Loggin]

5. Doesn't really say

2nd paragraph addresses first time users:

two bills that would limit the quantity of opioid pain medications that doctors and other providers can prescribe patients who are obtaining opioids for the first time.

[RKP5637]

6. I see, thanks! n/t

[Aristus]

7. For treatment of rheumatoid arthritis, at least, controlling the pain is only one of several

important factors. The most important, from a quality of life standpoint, is controlling, or ameliorating the effects of, chronic joint inflammation.

Chronic joint inflammation presents with pain, redness, warmth, and swelling. But the end effect over time is those twisted, crabbed, deformed hands and fingers one saw fairly frequently in the elderly, or long-term sufferers of RA. You don't seem them as much anymore, due to medications called DMARDS, Disease-Modifying Anti-Rheumatic Drugs.

These medications are tricky to prescribe and manage, and are usually the province of specialists such as rheumatologists. These are the appropriate medications for sufferers of RA.