Living with Pain: Washington State’s Opioid Law Goes Too Far

Living with Pain: Washington State’s Opioid Law Goes Too Far

Bert Jones is in his late thirties and suffers constant pain from multiple sclerosis. Unfortunately for Bert, he lives in Washington State.

Unfortunate? Isn’t Washington– with its snow capped mountains, rain forests, and breathtaking ocean views — a beautiful place to live? Yes, it’s beautiful — unless you live with constant grinding pain like Bert and thousands of other Washingtonians.

In 2010, Washington’s legislature and governor succumbed to the constant drumbeat of hysteria in the press about the abuse, addictions and deaths caused by opioid medicine. HB 2876  was passed and signed into law, repealing the state’s guidelines on pain management and replacing them with tougher rules for chronic pain management; including dosage guidelines, mandated consultation with a pain specialist, and requirements for tracking opioid use.

This past January, the new law went into effect.

Predictable problems arose. The main problem is the requirement that a treating physician seek consultation with a pain specialist if the doctor prescribes an opioid dose above the amount established by the new regulations. On the surface this looks very reasonable. If there is an increased danger to the patient with a higher opioid dose, why not require the practitioner or the patient to consult an expert?

Doctors Drop Pain Patients

Doctors and clinics in Washington began to react. Many withdrew their services from pain patients, fearing increased scrutiny and possibly losing their licenses if they ran afoul of the new law. There was also concern about who would pay for the consultation with specialists, not to mention the delay in prescribing because of the mandated consultation. Treatment options for pain shrank.

Bert knows all about pain. In 2009, after years of escalating symptoms, Bert was diagnosed with multiple sclerosis, which attacks the nerves and can cause excruciating pain. Bert experienced temporary blindness and shocking pain on the right side of his face from recurring optic neuritis. He also developed pain in his left leg. Bert’s pain was treated by his neurologist with a combination of short and long acting opioids.

This past winter Bert received notice from his neurologist that he would only prescribe opioids for cancer patients. After a hurried search, Bert found another pain specialist who was willing to prescribe the same medicines. That his new doctor’s office was an hour away was a stumbling block, but a block he had to hurdle as he had gone five days without his opioid medicine and was suffering symptoms.

With gas prices hovering at $4.25 per gallon, Bert found that driving to his new physician was a big expense, causing wear and tear to his car and to his wallet. Unable to work because of his medical condition, Bert and his wife are dependent on her salary alone. Bert shouldn’t need his wife to take time off from work each month to take him to his physician to obtain his legal prescription. He shouldn’t have to endure the severe pain in his leg for the two hour monthly round trip, nor the added expense. Bert and the thousands like him should not be treated as potential criminals.

Shortage of Pain Physicians

HB 2876 is fundamentally flawed legislation. It erects significant barriers to treatment, as there are not enough pain specialists left in Washington to treat the patients abandoned by their doctors. The shortage is particularly acute in many rural areas. All of which leads to more anxiety and despair — which may raise the suicide rate of pain patients who cannot tolerate the unrelieved torture of constant harrowing pain.

The law also mandates that providers who suspect their opioid patients of illegal behavior to report them to law enforcement authorities, thus allying the physician with the state. This casts the shadow of suspicion across the therapeutic relationship and damages the necessity of mutual trust. Trying to curb illicit drug use on the backs of legitimate pain patients only furthers the prejudices and stereotypes of people with pain.

A better approach would be to combine education for prescribers and patients with patient monitoring programs (PMP) set up by the state. PMPs require the physician and pharmacist to report to a state registry the names of people receiving opioid medicines. Such a registry would allow physicians and pharmacists to see if a patient is doctor shopping to get an opioid prescription filled.Washington now has a PMP.

Washington should either repeal or drastically amend HB 2876 so that the “war on drugs” is not fought on the backs of legitimate patients using legitimate treatments to escape the torture of chronic pain.

 

Mark Maginn lives in the east bay of San Francisco where he is a poet, writer and social justice activist. He was also a longtime volunteer with the American Pain Foundation. Mark’s blog can be found here.

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There are 4 comments for this article
  1. Lynne at 8:51 am

    In some states laws may be out of line…in others more reasonable. I recently wrote this and would like to share it. Also wondering if there is a group to advocate for pain patients who are dropped. The american pain foundation no longer exists. Doctors are disappearing. Well you know that. Thank you for the article Mr. Maggin. Here is something:
    The APF AND government are doing all they can to protect the innocent with appropriate treatment while trying to stop the guilty abusers. It’s sad when a parent loses a child to drugs or anything else.
    AARP article gives this info:
    HHS study of Medicare patients:
    1 in 7 suffered serious or long term injuries or died as a result of medical care. Researchers said about 44% of problems were preventable.
    In Health Affairs: researchers examined patient carts at 3 America’ leading hospitals and found 1 in 3 ademissions included some type of harm to the patient. Mistakes…suggeon nicks a healthy blood vessel, nusre administers toxic does of meds, staff fails to adequately diinfect a room causing ‘superbug’ contractions. # patients die in preventable hospital errors is = 4 full jumb jets crashng each week.
    How many die of OD from prescription drugs? See CDC article:
    These drugs (opiods) were involved in 14,800 overdose deaths in 2008. Why was the article dated 12/2011 for stats in 2008?
    Also cdc reports 100 people die from drug overdoses every day in the United States
    US NEWS reports: December 30, 2011 RSS Feed Print The United States will enter 2012 with a population of roughly 312.8 million people (or exactly 312,780,968 people, if you want to be pedantic), according to the U.S. Census Bureau’s end-of-2011 estimate. That is .00003% of the entire population die from drug overdose.
    The CDC reports: and many as 98,000 Americans die each year due to medical error.
    That is .03% of the entire population. That is one thousand times MORE than the people that die from drug overdose!
    Why don’t we fx the medical problems? That is FAR worse than drug overdose!!!!
    With THAT in mind, while re all hate to hear of ANY deaths, especially young people, let us FOCUS ON WHAT THE REAL ISSUES ARE….THE WORST ISSUES!
    This was in response to a man who lost his child due to OD. He wanted opiods banned. Really!!????!

  2. Bert Jones at 10:46 pm

    I’ll go deeper since I am the Bert mentioned in the article. At the time of creating and passing HB 2876 here in Washington, it was said to be created to curb the number of deaths related to Prescription Drugs. I capitolized those for a reason. In Washington at the time, well, two years before this law as it takes about two years to tabulate data; at the time this was created, in Washington, our death rate of people dying from these drugs was a staggering 0.63%. No kidding, less than 1%. I also found out that deaths from Cocaine or Heroin are included in these numbers; this is why I capitolized Prescription Drugs. Despite my kindest voice or sweetest smile, no doctor will ever give me prescriptions for either of those drugs. Also, further study showed that 24.8% of these deaths occurred on Tribal lands (which Washington is one of the handful of States that has jurisdictional authority on Tribal lands). Where is law enforcement? The number one demographic of those who intentionally took their lives, which sadly does happen and has happened to friends and even in my family, is white males age 45-54, not exactly the drug dealer on the street type. Highest rate of longest unemployed is this same demographic, I sadly know this from a father who lost his job at 54 and remained unemployed 3 years. See, almost everything is based on age. At 16, one gets to drive, at 18, one gets to vote, at 21 one gets to drink (I firmly believe that if you can join the military and kill for our country at 18, you should be allowed a beer, but that is me), at age 22 womens car insurance rates go down, at age 25, mens car insurance goes down, at age 55 however, health insurance for men almost doubles. So firing them before 55 and replacing them with a 25 year old is the norm, sadly (vote democrat). But I digress. This law seemed to come from nowhere. Even the man whose name is on the bill first won’t say where he got the idea. I looked it up and got lucky. One of the sponsors happened to be in my district. I called her office and made my case. Washington is afterall the State with the highest occurrence of MS. I was invited to her office where I made my case in person. My wife came with me. I was then told that my Representative did in fact drop a bill to have this law suspended for further study (which has yet to happen). I pointed out that nobody can say where this idea came from. I pointed out that it was the work of Big Pharma as they have been trying to get newer designer drugs sold instead of old drugs that are cheap and available as generics. I was also invited to address the Health and Wellness committee here in Washington. I was given three minutes to speak. My first sentence was, “I was invited here today…” and then took 9 minutes. The following speakers were all doctors who had a financial benefit in pain management clinics. It should be pointed out that these newer drugs were usually intended for other illnesses, such as incontinence. Some or all were denied by the FDA until the drugs were taken out of country, rebadged, reformulated a little and their intended use changed. With the support and approval of other countries however, FDA approval became easier. Read any ad for Lyrica or Cymbalta. Read where it says… we don’t know why it works. The new drugs also cost ten to twenty times the cost of old drugs. The new drugs are not always covered by insurance either. I am a little lucky. My wife and I have good insurance and she is a kick ass attorney. But I will be damned if I sit by and watch Big Pharma slowly go from State to State because it is easier and cheaper than lobbying for the entire country. I encourage anyone who suffers from neuropathic pain, even Multiple Sclerosis like me, to be on the lookout for this happening in your State. It is coming. Be prepared to fight it. It is your Government when it comes to the Statehouses, they aren’t as bought off as Nationally elected members. They also usually don’t know the mood on the street unlesss that mood is brought to them. Don’t let it happen in your State, if not already.

  3. Annie Sisk at 4:30 pm

    Shannon is absolutely correct. The government’s own statistics show that the rate of occurrence of addiction in patients who’ve been prescribed opioid medication for chronic pain is about 3%, and further that when you factor out the people with a track record of abuse and addiction, that figure drops to LESS than 1%. The deaths from overdose in 2008 were half that of the number of deaths from car accidents, but I don’t see anyone radically restricting access to driver’s licenses. The problem with legislative approaches, as well as the “pain contract” and “let’s prosecute the doctors” approaches, is that the only people such tactics hurt are those who take their medication appropriately and are NOT addicted, because the nature of addiction means that addicts will ALWAYS find a source for their next fix, usually an illegal one. They’re not going to be stopped by this law. And thus the ill-conceived, even-more-poorly-executed war on drugs turns into a war on chronic pain patients, who become ever more marginalized, powerless, and ostracized, even as they want to recover, be productive members of society, and live their lives in peace.

  4. Shannon at 2:46 pm

    Mark,

    Thank you! Thank you for finally bringing light to this injustice to pain patients in Washington. It worries me that this law is being eyed for the nation. Notice too all the problems in Canada with the recent total ban on Oxycontin. And there’s federal legislation pending for another pain bill that concerns me greatly which I wrote about on my blog:

    it seems like every day I sees articles spouting statistics to make it seem like half the country is hooked on pain medication and it’s just one big wild drug orgy. I’m not a statistics buff, but I know they are skewing the numbers to support their position. (Annie, can you help me with this?)

    It is such a disservice to legitimate pain patients like myself who do not have cancer and use our medication as prescribed. Are we just supposed to give up our meds and wave goodbye to the lives we have? Many can only work with the help of their meds, so let’s add more numbers to the disability system. Let’s overload the health care system as suffering legitimate pain patients who previously were managing well are desperate for help just to get through the day. But then of course, we will just be labeled drug addicts and looked down upon. Society will mock that we can’t pick ourselves up with a smile, suck it up, and shut up. Since our pain can’t be seen or measured society believes we were always faking it anyway… and these anti-opioid groups seem to believe if we don’t have cancer our pain is negligible at best – seems like the same problem, doesn’t it?

    Keep up the good work, Mark. Maybe you could do an interview with Dr. Portenoy on this issue? I think doctor education on pain management is important, as he does. There has to be a balance and this hysteria is clouding the issue.

    Blessings,
    -Shannon