Start discussion: Should the state mandate a limit on pain medications?

[Waterbuffalo]

There is a discussion at the state of Washington level to limit pain medicines of the narcotic variety.

Here is an article on the point they using as an educational guide but my question is: What do you think?

I have been reading this discussion in the Seattle and Eastern Washington Newspapers over the past six month but would love to see what others think.

Read here: http://seattlepi.nwsource.com/local/345714_pain02.html

[Chief]

From the article...

Washington state became a battlefront in the pain war earlier this year when a group of state agency medical directors, led by Dr. Gary Franklin of the Department of Labor and Industries and in consultation with practicing pain specialists, issued voluntary guidelines to physicians for prescribing opioids for noncancer pain. Opioids such as OxyContin are powerful painkillers that mimic morphine. Heroin is made from morphine.

The state's chief recommendation is that doctors limit the total opioid dose to the equivalent of 120 milligrams of morphine a day. At that level, the state urges doctors to seek a consultation with a pain management specialist. No other state recommends a dosing limit, although others are exploring the idea.

The dosing guideline is about half the maximum average daily dose of 250 milligrams taken in recent years by injured workers and Medicaid clients with chronic, noncancer pain, according to Franklin. Doses in some cases exceeded 1,000 milligrams, he said. In contrast, some cancer specialists say their patients with chronic pain might require more than 600 milligrams of morphine a day.

I can speak with some knowledge on this. I have been under treatment for cronic cancer pain for nearly a decade, and I have weaned myself off of oxycontin three different times. I was also on Fentanyl patches, 75 mg/day with each patch lasting three days. It was brutal. On one hand I hurt so bad I welcomed the relief, but I was constantly puking my shoes out, and I often didn't know which one of the Jones Boys I was. I went for a year where I did not drive because I knew I was incapacitated. It took transitioning to Oxycontin to break the fentanyl jones, and then sheer guts to drop the Oxy. It was one of the hardest things I've ever done in my life.

The addiction to pain killers out here is rampant. I don't use Oxy any longer, but I do have an emergency stash on hand if I need it. My cancer is stable, but I have ongoing conditions that still require treatment, along with cramping in my neck that can get quite painful. I use over the counter meds whenever I can, and I stay away from the hard stuff for when the day comes, and God help me that it never does, that I may need that hard-core pain relief again.

I don't see how setting arbitrary levels of what can be prescribed for non-cancer pain relief will help. I do think that pain relief specialists are in short supply, and that chronic pain is vasty misunderstood by a lot of nursing staff at hospitals where they are usually liimited to the 10-point pain chart to judge what pain a patient is experiencing.

I don't know what the answers are, but by publishing these "voluntary guidelines", the subject is on the front burner, so I'll be interested to follow this discussion as it unfiolds.

[Waterbuffalo]

I'll add that this discussion has been in the seattle papers and media for the past year. So if your interested in the subject, I would be looking north for more information.

I also have been on huge amounts of pain meds for all the surgeries I have had over the past 8 years. Lucky I'm not addicted or have them now.

Do hope people do find what they need for pain control.

[tefen]

I know of an acquantance who reportedly gets oxycontin prescribed by his dentist. I think there definitely should be some sort of oversight, though maybe specific inquiries into the patients rather than just a blanket limit. I just can't imagine that his teeth can hurt that badly.

[Chief]

That's my point too tefen. How can you get repeated refills for oxy for tooth pain?? The whole point of going to the dentist is to fix the pain, not to live with it via oxycontin.

[Waterbuffalo]

What was the reason Tefen for your acquaintance getting oxycontin for his pain? I can't sit there and judge the person before I have the facts. There might have been a valid reason why he needed it. Broken Jaw, oral problems other than just a tooth ache...

[tefen]

From what I've heard, recreational use only. I have heard many stories from friends of him selling and sharing pain meds.

Anyway, the point isn't about this individual. I believe there is abuse going on out there, and some sort of monitoring should take place. I don't, however, believe that it should consist of a flat "limit" without taking into consideration the individual circumstances of the patient. Perhaps instead of referring to a pain specialist BEFORE prescribing, the prescription of significant dosage should trigger an inquiry into the patient's specific needs.

[Waterbuffalo]

"Perhaps instead of referring to a pain specialist BEFORE prescribing, the prescription of significant dosage should trigger an inquiry into the patient's specific needs."

Sounds like a smart idea to me!

[Chief]

Would you not think that was already going on??

[tefen]

The state's chief recommendation is that doctors limit the total opioid dose to the equivalent of 120 milligrams of morphine a day. At that level, the state urges doctors to seek a consultation with a pain management specialist.

No Chief, from the text you posted above, it sounds like the state is recommending that doctors limit the dosage and consult a specialist before going higher. It also doesn't sound like there's any kind of double check out there. No one is checking out those cases that go over the recommendation and which don't get referred to a specialist.

As much as I would like to believe that every doctor is doing his professional duty to write appropriate prescriptions, I doubt that's always the case.

[Chief]

And terein lies the basis for a black market trade in oxy. Sounds like the Pain Specialist would be the answer, but again, they are in very short supply.

[Waterbuffalo]

Basically its a non-winning solution that seems to be recycling a bunch in the past few years. Wonder what the best solution could be that hasn't been said yet.

There are not a lot of doctors specializing in pain medicine or control thereof. So what could be the answer that the state of washington hasn't found yet?