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Eshb 2876

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How are non-pain management PA’s dealing with the implementation of ESHB 2876 which regulates the use of chronic opiates in non-end of life scenarios? You should have all gotten the letter from the WSDOH.

I have a number of patients on chronic opiates in most cases for orthopedic issues of one form or another. A few are over the 120mg morphine equivalent and I have referred their cases to pain clinics for review (4 out of 5 cases they concurred with the treatment, the 5th case I think the NP that was doing the eval was having a bad day). These are patients that are poor candidates for surgeries or NSAIDS. Some physicians that I work with have advocated not prescribing any opiates at all in fear of legal ramifications from the state. I am completing the necessary CME to continue prescribing and stay within compliance of the law.

The guidelines say that age over 65 years as inversely related to opiate abuse risk. I have found through drug screening that just as many over 65 as under 65 have screenings that either are not consistent with medications prescribed or have illicit drugs present. Anyone else find this?

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I did not get a letter. I just read through the bill and it doesn't look like it will affect my practice at all as I work in emergency medicine. acute pain from injury or surgery is specifically treatable outside the realm of this bill. I will not be taking the 4 hr class.

as a pcp I can see why one would need to but I hope never to rx metadone or chronic narcotics from the er.

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Ditto emedpa.

Excepting the end stage/ end of life cancer patient that hospice has sent to the hospital to die ( another thread entirely), who needs adjustment of IV anxiolytics and narcotics to aid in their last few hours, I do not give or refill chronic narcotics. And am specifically prohibited from giving methadone as I am not a pain management specialist. Does the op think that I should take the training?

I moonlight once a week in a clinic run by a friend of mine. Like most such clinics, he will not accept chronic pain patients, thinking that the potential abuse and liabilities, along with administrative requirements, by far outweigh the small group of legitimate beneficiaries.

If we do not accept chronic pain patients, I do not see where I will need the training.

And I have not heard that we will be REQUIRED to accept chronic pain patients. Yet....

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Washington State Legislature Medical quality assurance commission




246-919-800 Purpose. (Effective Until January 2, 2012.)

246-919-810 What specific guidance should a practitioner follow? (Effective Until January 2, 2012.)

246-919-820 What knowledge should a practitioner possess to treat pain patients? (Effective Until January 2, 2012.)

246-919-830 How will the commission evaluate prescribing for pain? (Effective Until January 2, 2012.)



246-919-850 Pain management -- Intent.

246-919-851 Exclusions.

246-919-852 Definitions.

246-919-853 Patient evaluation.

246-919-854 Treatment plan.

246-919-855 Informed consent.

246-919-856 Written agreement for treatment.

246-919-857 Periodic review.

246-919-858 Long-acting opioids, including methadone.

246-919-859 Episodic care.

246-919-860 Consultation -- Recommendations and requirements.

246-919-861 Consultation -- Exemptions for exigent and special circumstances.

246-919-862 Consultation -- Exemptions for the physician.

246-919-863 Pain management specialist.



No PAs....:sweat:

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No PAs....:sweat:


PA's can manage chronic pain per the law. Doses under the 120mg limit are not controversial as long as there is documentation to support the use. I will be continuing to prescribe lesser doses chronically and higher doses as long as they are reviewed and approved by a pain specialist.

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