Wash. state earns 'A' grade for pain prescribing, for now

Jun 4, 2013

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Washington state has earned a top grade from the American Cancer Society when it comes to helping people suffering from long-term pain. However, the state’s law on pain medication is unusual enough that the Cancer Society is surveying doctors to learn more about how it’s working.

In the past, many patients in chronic pain—lasting months or years—believed they were just supposed to suffer through it.

"That’s not necessarily true. You don’t need to be in pain because you are a cancer patient. Your pain should be treated," said David Woodmansee of the American Cancer Society Cancer Action Network, the advocacy arm of the Cancer Society.

The ACS has a new set of grades for all 50 states evaluating how they approach pain treatments and prescription narcotics, based on research from the University of Wisconsin.  

Washington is one of 13 states that earned an "A" grade.

"What we ask for is balance, state by state," said Woodmansee. "Yes, law enforcement, please get those who are abusing these or diverting these (drugs). But while you're doing that, please don’t make criminals out of cancer patients and others with chronic diseases."

Washington had a B+ in the set of last rankings, back in 2008. In between, a controversial new law took effect. It gets praise for supporting access to painkillers. But patients have complained about being required to visit a pain specialist if they're getting high doses. They fear the law may have a chilling effect on non-specialists. 

Meanwhile, pain specialists at the University of Washington and Group Health want doctors to consider other approaches, saying pain treatments are too often reduced to narcotics or nothing.

The Cancer Society is currently asking doctors across the state for feedback on the law, which is being watched across the country. Depending on what they learn, they could come back and lower the state’s grade later this year.

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13 states that earned an A:

  • Georgia
  • Iowa
  • Kansas
  • Maine
  • Massachusetts
  • Michigan
  • Montana
  • Oregon
  • Rhode Island
  • Vermont
  • Virginia
  • Washington
  • Wisconsin

Criteria used to grade the states:

All states’ relevant policies were reviewed using these criteria.

Positive and negative provisions were counted, and a grade was calculated for each state.

Positive provisions: Policy language with the potential to enhance pain management:

1. Controlled substances are recognized as necessary for the public health

2. Pain management is recognized as part of general healthcare practice

3. Medical use of opioids is recognized as legitimate professional practice

4. Pain management is encouraged

5. Practitioners’ concerns about regulatory scrutiny are addressed

6. Prescription amount alone is recognized as insufficient to determine the legitimacy of prescribing

7. Physical dependence or analgesic tolerance are not confused with “addiction”

8. Other provisions that may enhance pain management

Negative provisions: Policy language with the potential to impede pain management:

9. Opioids are relegated as only a treatment of last resort

10. Medical use of opioids is implied to be outside legitimate professional practice

11. Physical dependence or analgesic tolerance are confused with “addiction”

12. Medical decisions are restricted

13. Length of prescription validity is restricted

14. Practitioners are subject to additional prescription requirements

15. Other provisions that may impede pain management

16. Provisions that are ambiguous

Source: Pain and Policies Study Group, Univ. of Wisconsin