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March 21, 2007

State medical directors agree on new guidelines for prescribing narcotics

OLYMPIA — State health officials have published new guidelines to help doctors evaluate and monitor dosage levels of narcotics prescribed to treat patients with chronic pain. The guidelines are part of a yearlong educational campaign sponsored by a panel of Washington state medical directors from six state agencies.

“The new guideline is an effort to improve patient care and safety,” said Dr. Gary Franklin, Department of Labor & Industries (L&I) medical director and chairman of the Agency Medical Directors Group, sponsor of the new guidelines.

L&I data shows that between 1996 and 2002 there were 32 deaths among injured workers where an accidental overdose of prescription opioids, or narcotics, was confirmed. This is part of a larger trend of increasing deaths related to prescription opioids. Statewide, deaths involving prescription opioids — sometimes used illegally — increased by more than 800 percent from 1995 to 2004.

“Because prolonged, high-dose opioid therapy can be unsafe or can become less effective, we want to provide clear guidance in this area for primary-care providers,” Franklin said.

The guidelines do not apply to the treatment of acute pain, cancer pain or end-of-life (hospice) care.

The guidelines also do not dictate dosages, but recommend that generally the total daily dose of opioids should not exceed 120 milligrams of morphine or its equivalent if both pain and physical function are not improving. A web-based calculator helps doctors establish dosages of combinations of different opioids that stay within the guidelines.

The guidelines also recommend monitoring pain therapy for safety and effectiveness. If a patient’s dose has moved up to 120 milligrams without improvement in both pain and function, the guidelines recommend getting a second opinion from a doctor experienced in pain management.

Staff from state agencies collaborated on the guidelines with practicing physicians who specialize in pain management. They are intended as a resource for primary-care providers treating patients covered by state agency programs and will be the focus of the year-long educational campaign.

The guidelines, dosage calculator and related tools are available at a new web site developed by the Agency Medical Directors Group: www.agencymeddirectors.wa.gov. The group is made up of the medical directors from the departments of Corrections, Health, Health Care Authority, Labor & Industries, Social and Health Services, and Veterans Affairs.

Washington is believed to be the first state to form this kind of coalition of medical directors with a commitment to work together and with state health-care providers to improve health-care quality.

Together, those six agencies provide health care to 1.3 million Washington state residents each year at an estimated cost of $4.5 billion, up from $2.7 billion in 2000.

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Media contact: Barbara A. Davis, Department of Labor & Industries Public Affairs, at 360-902-4216 or daba235@LNI.wa.gov

Broadcast version
A panel of medical directors from six state agencies, in collaboration with clinical pain experts, has agreed to a yearlong educational campaign to help doctors use a new set of narcotics dosage levels for patients suffering chronic pain.

“The new guideline is an effort to improve patient care and safety,” said Dr. Gary Franklin, Department of Labor & Industries medical director and chairman of the Agency Medical Directors Group, sponsor of the new guidelines.

The guidelines are intended as a resource for primary-care providers treating patients covered by state agency programs. They do not apply to the treatment of acute pain, cancer pain or end-of-life (hospice) care.

The guidelines and other information can be found at www dot agencymeddirectors dot wa dot gov.

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