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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