As you may have heard, the State of Washington has recently enacted a series of laws that will profoundly affect the ability of a patient with chronic non-cancer pain to receive opioids or narcotics on prescription from their physician. First, such patient must go only the “pain specialists” (Thereby imposing a burden on people living in rural areas) and then not only must the doctor disclose detailed medical information about the patient to the state, but patients too are required to fill out questionnaires each time they see their physicians.

Worst yet, beginning in mid-2011, a committee of physicians, presumably controlled by the University of Washington Medical School, which, with its rigid insistence upon the "cognitive behavioral" school of treatment - there is no cure and the patient's worst enemy is self-pity - was actually responsible for the enactment of the statutes in the first place, will have the authority (under the guise of “best medical practices’) to actually mandate the terms and conditions under which physicians may prescribe such drugs. “Move to Restrict Pain Killers Puts Onus on Doctors, by Barry Meier, New York Times, July 28, 2010 http://www.nytimes.com/2010/07/29/bu...hington&st=cse

As set forth in both the NY Times article and now the NEJM, there is an actual question as to how long pain management specialists in the State of Washington may be willing to endure the hassle of actually "treating" patients with intractable pain, before they either abandon the treatment of such patients or pull up their stakes and go elsewhere. See, "Regulating Opioid Use in Washington State," which appears as a single page sub-article (p. 1984) to a "Perspective" piece that takes another tack altogether, A Flood of Opioids, a Rising Tide of Deaths, Susan Okie, M.D, New England Journal of Medicine, Nov. 18, 2010, pp. 1981 - 1984, FREE ONLINE TEXT @ http://www.nejm.org/doi/pdf/10.1056/NEJMp1011512

In either case, the combined effects of these new laws may be terrible for RSD/CRPS patients, especially if someone at the state/University of Washington takes the (anonymous) patient questionnaires through statistical analysis and publishes an article to the effect that the mean reduction of pain levels is sufficiently insignificant as to not be worth the risk of using potent opioids or narcotics. Whereupon the “Best Medical Practices Committee” convenes and determines that certain opioids or narcotics cannot be prescribed (or prescribed beyond a given level) in the treatment of CRPS.

(That’s what lawyers refer to as a “parade of horribles,” but there it is.)

Mike


ps Nor am I particularly happy that the NEJM chose to run Dr. Okie's opinion piece as what appears as the lead article in its online issue of 11.18.10. http://www.nejm.org/toc/nejm/363/21