Washington 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 year-long 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 and 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, he indicated.
“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 doctor’s opinion.
Staff from state agencies collaborated on the guidelines with practicing physicians who specialize in pain management. The guidelines, dosage calculator and related tools are available at a 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 and Industries, Social and Health Services, and Veterans Affairs.
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