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

I have heard of this bill in Washington. I did not realize they passed this turkey? I think one has to take a close look at the people who worked this bill and research to see if any of their family members have chronic conditions and catch them cheating the system because that is exactly what will happen. I pray this does not set a precedent for other states to follow because we will move out of the US if we have to and was thinking about doing just that anyway after the hell both of us have gone through the past several years. I swear sometimes think I live in bazzaro world.

Simply hard to believe....

Mike,
As always, Thanks for the 'Heads Up'!

What can we do, to whom can we write?

We don't want to see this go down in WA, nor trickle to other states!

Again,
My Thanks!

Pete


asb

Pete -

What to do? First things first, I invite anyone to go the Dr. Okie's "perspective article" with a fine tooth comb and send some scathing letters to the editor of the NEJM, not that they will be published. Better yet, encourage your doctors to do so. Off hand, I think the best attack is a numbers game: I suspect there are far many more people in intractable pain in this country than who perish through recreational abuse if these drugs: by several orders of magnitude. Whether our population is equaled by a group of abusers in Appalachia is another matter, but then the argument becomes the immorality of condemning some to pain just so other can't have what passes for fun. (Somewhere, the cold hand of Calvin has to be involved in this one.)

For specific information, the best source right now appears to be the American Pain Foundation. Here's their page on the subject: http://www.painfoundation.org/take-a...fforts/wa.html

Purdue Pharmaceuticals (maker of OxyContin) probably has a good hand on the numbers as well. It's a corporate sponsor of the RSDSA, so Jim Broatch might be a good point of contact.

Just a few thoughts . . .

Mike

I cannot believe in this country, that this type of thing could happen. Evidently none of the people sponcering this bill have never had pain of any kind much less NP, or the hurtfull conditions people have all over this country. The ignorance of those folks is frightening. Most people who use opiods for true pain are not doing it because they want to, they do it because they have to, to be able to have some kind of quality to their lives. We should write to our state senators and maybe become more active in protesting such bills. This would place unfair restrictions on pain specialists, and take time away from the patients.