Washington State Enforces New Rules for Prescribing Painkillers

The New York Times is reporting that Washington State is apparently the first in the country to develop regulations to prevent doctors from prescribing dangerously high doses of painkillers. NYT writes, “The effort, in Washington State, represents the most sweeping attempt yet to stem what some experts see as the excessive use of prescribed narcotics, and it is being closely watched by medical professionals elsewhere. Among other things, Washington would apparently become the first state that would require a doctor to refer patients on escalating doses of pain killers for evaluation if they were not improving.”
In Washington, prescription drug overdoses have become an epidemic, surpassing motor vehicle crashes among people ages 35-45. Experts in pain treatment and drug abuse prevention say the growing use of long-acting pain killers like OxyCotin, fentanyl and methadone has become a crucial factor in a nationwide epidemic of overdose deaths, largely from the abuse of such drugs.
The state Department of Health declares that the rate of death from prescription overdoses has increased 90 percent between 2003 and 2008. More and more Americans are landing in hospitals due to poisoning by powerful prescription painkillers, sedatives and tranquilizers. A number of celebrities have died from prescription overdoses, including Health Ledger, Michael Jackson, and Anna Nicole Smith. Between 1999 and 2006, US hospital admissions due to poisoning by prescription opioids, sedatives and tranquilizers rose from approximately 43,000 to about 71,000. This 65 percent increase is about double the increase observed in hospitalizations for poisoning by other drugs and medicines.
Opioids include morphine, methadone, OxyContin and the active ingredient Percocet are powerful narcotic painkillers that can be habit-forming. Examples of sedatives or tranquilizers include Valium, Xanax, and Ativan.
The difficulty in preventing overdoses is compounded by the drugs’ dual nature; people use them both recreationally and legitimately for pain purposes. The state Legislature has directed a medical panel to come up with a set of practices that would be required in prescribing narcotics. State health officials have published new guidelines to help doctors evaluate and monitor dosage levels of narcotics prescribed to treat patient with chronic pain. The guidelines are part of a yearlong educational campaign sponsored by a panel of Washington state medical directors from six state agencies. These guidelines are in effort to improve patient care and safety. These guidelines will not apply to the treatment of acute pain, cancer pain or end-of-life (hospice) care.
These guidelines are intended as a resource for primary-care providers treating patients covered by state agency programs. The guidelines, dosage calculator and related tools are available at a new web site developed by the Agency Medical Directors Group: www.agencymeddirectors.wa.gov.
Washington is the first state to form this kind of coalition of medical directors with a commitment to work together and with state health-care providers to improve health-care quality.