Washington State Opioid Prescribing Guidelines

These are difficult times for the pain practitioner. Long held beliefs about efficacy of interventions with a steady patient flow to our offices is being challenged by the payers including Medicare and Medicaid. Traditional medications including antidepressants, anticonvulsants, nonsteroidal anti inflammatories show questionable benefit especially in long-term use. Physical therapy, chiropractic, massage, pool therapy is limited or poorly reimbursed. The much discussed and supported cognitive behavioral therapy and intensive, interdisciplinary pain rehabilitation is available to almost no one. And the current hot button item to the media is inappropriate prescribing of opioids with unintentional overdose deaths. Having been involved as an expert in many defense cases, even the careful, contentious pain practitioner could find his or her practice being challenged in court; the subtleties of practice with the nuances of patient interactions being left to largely uninformed juries. One such case I reviewed recently concluded in Boston with the federal government accusing the practitioners of criminal activities including drug trafficking. The trial exonerated the doctor and his nurse practitioner on all counts, but as you well know, the damage to these providers and to those …