Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-817 - Dental quality assurance commission › OPIOID PRESCRIBING › Opioid Prescribing-General Provisions › Section 246-817-906 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The definitions in this section apply to WAC
						246-817-901
						through 246-817-980 unless the context clearly requires otherwise:
(1) "Aberrant behavior" means behavior that
					 indicates misuse, diversion or substance use disorder. This includes, but is
					 not limited to, multiple early refills or renewals, or obtaining prescriptions
					 for the same or similar drugs from more than one dentist or other health care
					 practitioner.
(2) "Acute pain"
					 means the normal, predicted physiological response to a noxious chemical,
					 thermal, or mechanical stimulus and typically is associated with invasive
					 procedures, trauma, and disease. Acute pain is considered to be six weeks or
					 less in duration.
(3) "Biological
					 specimen test" or "biological specimen testing" means tests of urine, hair or
					 other biological samples for various drugs and metabolites.
(4) "Chronic pain" means a state in which
					 pain persists beyond the usual course of an acute disease or healing of an
					 injury, or that may or may not be associated with an acute or chronic
					 pathologic process, that causes continuous or intermittent pain over months or
					 years.
(5) "Comorbidities" means a
					 preexisting or coexisting physical or psychiatric disease or
					 condition.
(6) "High dose" means
					 ninety milligram MED or more, per day.
(7) "High-risk" is a category of patient at
					 increased risk of morbidity or mortality, such as from comorbidities,
					 poly-pharmacy, history of substance use disorder or abuse, aberrant behavior,
					 high dose opioid prescription, or the use of any central nervous system
					 depressant.
(8) "Hospice" means a
					 model of care that focuses on relieving symptoms and supporting patients with
					 life expectancy of six months or less.
(9) "Hospital" means any institution, place,
					 building, or agency licensed under chapter 70.41 or 71.12 RCW, or designated
					 under chapter 72.23 RCW to provide accommodations, facilities, and services
					 over a continuous period of twenty-four hours or more, for observation,
					 diagnosis, or care of two or more individuals not related to the operator who
					 are suffering from illness, injury, deformity, or abnormality, or from any
					 other condition for which obstetrical, medical, or surgical services would be
					 appropriate for care or diagnosis.
(10) "Low-risk" means a category of patient
					 at low risk of opioid induced morbidity or mortality, based on factors and
					 combinations of factors such as medical and behavioral comorbidities,
					 polypharmacy, and dose of opioids of less than 50 MED.
(11) "Medication assisted treatment" or "MAT"
					 means the use of pharmacologic therapy, often in combination with counseling
					 and behavioral therapies, for the treatment of substance use
					 disorders.
(12) "Moderate-risk"
					 means a category of patient at moderate risk of opioid induced morbidity or
					 mortality, based on factors and combinations of factors such as medical and
					 behavioral comorbidities, polypharmacy, past history of substance use disorder
					 or abuse, aberrant behavior, and dose of opioids between 50-90 MED.
(13) "Morphine equivalent dose" or "MED"
					 means a conversion of various opioids to a morphine equivalent dose by the use
					 of accepted conversion tables.
(14)
					 "Multidisciplinary pain clinic" means a facility that provides comprehensive
					 pain management and includes care provided by multiple available disciplines,
					 practitioners, or treatment modalities.
(15) "Nonoperative pain" means acute pain
					 which does not occur as a result of surgery.
(16) "Opioid analgesic" or "opioid" means a
					 drug that is used to alleviate moderate to severe pain that is either an opiate
					 derived from the opium poppy or opiate-like that is a semi-synthetic or
					 synthetic drug. Examples include morphine, codeine, hydrocodone, oxycodone,
					 fentanyl, meperi-dine, and methadone.
(17) "Palliative care" means care that
					 maintains or improves the quality of life of patients and their families facing
					 serious, advanced, or life-threatening illness. With palliative care particular
					 attention is given to the prevention, assessment, and treatment of pain and
					 other symptoms, and to the provision of psychological, spiritual, and emotional
					 support.
(18) "Pain" means an
					 unpleasant sensory or emotional experience associated with actual or potential
					 tissue damage, or described in terms of such damage.
(19) "Perioperative pain" means acute pain
					 that occurs as the result of surgery.
(20) "Practitioner" means an advanced
					 registered nurse practitioner licensed under chapter 18.79 RCW, a dentist
					 licensed under chapter 18.32 RCW, a physician licensed under chapter 18.71 or
					 18.57 RCW, a physician assistant licensed under chapter 18.71A or 18.57A RCW,
					 or a podiat-ric physician licensed under chapter 18.22 RCW.
(21) "Prescription monitoring program" or
					 "PMP" means the Washington state prescription monitoring program authorized
					 under chapter 70.225 RCW.
(22)
					 "Subacute pain" is considered to be a continuation of pain, of six to twelve
					 weeks in duration.
(23) "Substance
					 use disorder" means a primary, chronic, neurobiological disease with genetic,
					 psychosocial, and environmental factors influencing its development and
					 manifestations. Substance use disorder is not the same as physical dependence
					 or tolerance that are normal physiological consequences of extended opioid
					 therapy for pain. It is characterized by behaviors that include, but are not
					 limited to, impaired control over drug use, craving, compulsive use, or
					 continued use despite harm.