A law in Washington State requires doctors to refer patients taking high doses of opioids for evaluation by a pain specialist if their underlying condition does not improve. The law passed last year is aimed at reducing the epidemic of prescription drug abuse. Ohio is considering similar legislation, The New York Times reports.
Some doctors in Washington have stopped treating pain patients, the article notes.
It is common for doctors prescribing pain medications not to monitor patients, and to simply prescribe an increasing amount, says Dr. Claire Trescott of Group Health in Seattle. She told the newspaper that is because treating pain patients, who are often also anxious or depressed, can be difficult and time-consuming. She said doctors end up treating the pain, instead of the underlying condition.
The Washington law sets a painkiller dosage level that requires a referral, which has created controversy. Several national pain experts said the provision would restrict patient access to care, and the maker of OxyContin, Purdue Pharma, also opposed the measure. Even some proponents of the law said there was a lack of evidence to support the dosage threshold.
Group Health treats 420,000 patients at 25 clinics throughout Washington. The health care system has placed controls on how painkillers are prescribed.
Over the last four years, Group Health says it has cut the percentage of patients on high opioid dosages in half, and decreased the average daily dose in patients who regularly take opioids by one-third.
The system is now studying how those changes have affected patients. The newspaper notes other studies have suggested many chronic pain patients may derive significant benefits from lower opioid use, such as much higher recovery rates.