State officials say Washington's new pain-management law will help reverse a rising tide of overdose deaths. But the law does nothing to specifically address the risks of methadone — by far, the state's number-one killer among long-acting pain drugs.
What's more, hundreds if not thousands of patients have been denied life-enabling medications, cut off or turned away by doctors leery of the burdens and expense imposed by lawmakers, according to hospital representatives and consumer advocates.
At least 84 clinics and hospitals now refuse new pain patients, and some have booted existing patients, The Times found. The growing legion of untreated pain patients has become so troublesome that some clinics, like one in Everett, post signs that ward off walk-ins: "We do not treat pain patients." Across the nation, the annual death toll from prescription painkillers continues to escalate, more than tripling from 1999 to 2008, according to statistics that federal health officials released last month.
Confronted with this epidemic, health officials in other parts of the country have been eying Washington's groundbreaking law with special interest, says Dr. Lynn R. Webster, medical director of a Utah pain-research center and a national expert on preventing abuse of narcotic painkillers.
But Washington's approach, he says, is not a model worth emulating. He told The Times: "If other states follow suit, many patients could suffer needlessly."
Coupled with new rules passed by medical licensing boards, the law requires practitioners to document patient backgrounds and track behavior; conduct random urine screenings; and — most important of all — consult with a pain specialist if daily doses exceed the equivalent of 120 milligrams of morphine. Cancer and hospice patients are exempt, as are post-surgical patients and those with pain from sudden injury.
Washington has at least 1.5 million people who struggle with chronic or acute pain, the American Academy of Pain Management estimates. The state has thousands of practitioners with prescribing privileges. But as of last month, the state's sanctioned list of pain specialists numbered just 13.
The state's new rules, passed by licensing boards, give a nod to methadone. Yet, at least 2,173 people died in Washington by accidentally overdosing on methadone between 2003 and 2010, a Seattle Times analysis of death certificates shows. Among long-acting painkillers — a group that includes OxyContin, fentanyl and morphine — methadone accounts for less than 10 percent of the drugs prescribed but more than half the deaths. The drug has taken a particularly dramatic toll among the poor, who account for about half of the fatalities. To save money, the state steers Medicaid patients and recipients of workers' compensation to methadone, one of only two long-acting painkillers on the state's list of preferred drugs.
In summary, the State of Washington is restricting patient access from the safest and best array of drugs for chronic pain; moving them to instead to the cheaper methadone, which is the largest single drug contributing to accidental overdoses. The State has at least 1.5 million people who struggle with chronic or acute pain, but only 13 approved practitioners authorized for chronic pain management. Lost in this gigantic mess are those 1.5 million patients who will find it difficult, if not impossible to obtain their prescriptions. Forced to go without their medication or to use one that doesn't help them, these patients will increasingly turn to illegal drugs, theft, forging prescriptions or, sadly, suicide.
Who will help the 1.5 million chronic pain patients of Washington when their proven medications are no longer available and methadone fails to help? Who will help the families of methadone patients who accidentally overdose on it?
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