Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-918 - Physician assistants Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-918-800 - Intent and scope

Current through Register Vol. 24-14, July 15, 2024
The rules in WAC 246-918-800 through
					 246-918-935
					 govern the prescribing of opioids in the treatment of pain.
The commission recognizes that principles of quality
					 medical practice dictate that the people of the state of Washington have access
					 to appropriate and effective pain relief. The appropriate application of
					 up-to-date knowledge and treatment modalities can serve to improve the quality
					 of life for those patients who suffer from pain as well as reduce the
					 morbidity, mortality, and costs associated with untreated or inappropriately
					 treated pain. For the purposes of these rules, the inappropriate treatment of
					 pain includes nontreat-ment, undertreatment, overtreatment, and the continued
					 use of ineffective treatments.
The diagnosis and treatment of pain is integral to the
					 practice of medicine. The commission encourages physician assistants to view
					 pain management as a part of quality medical practice for all patients with
					 pain, including acute, perioperative, subacute, and chronic pain. All physician
					 assistants should become knowledgeable about assessing patients' pain and
					 effective methods of pain treatment, as well as statutory requirements for
					 prescribing opioids, including co-occurring prescriptions. Accordingly, these
					 rules clarify the commission's position on pain control, particularly as
					 related to the use of controlled substances, to alleviate physician assistant
					 uncertainty and to encourage better pain management.
Inappropriate pain treatment may result from a physician
					 assistant's lack of knowledge about pain management. Fears of investigation or
					 sanction by federal, state, or local agencies may also result in inappropriate
					 treatment of pain. Appropriate pain management is the treating physician
					 assistant's responsibility. As such, the commission will consider the
					 inappropriate treatment of pain to be a departure from standards of practice
					 and will investigate such allegations, recognizing that some types of pain
					 cannot be completely relieved, and taking into account whether the treatment is
					 appropriate for the diagnosis.
The commission recognizes that controlled substances
					 including opioids may be essential in the treatment of acute, subacute,
					 perioperative, or chronic pain due to disease, illness, trauma, or surgery. The
					 commission will refer to current clinical practice guidelines and expert review
					 in approaching cases involving management of pain. The medical management of
					 pain should consider current clinical knowledge and scientific research and the
					 use of pharmacologic and non-pharmacologic modalities according to the judgment
					 of the physician assistant. Pain should be assessed and treated promptly, and
					 the quantity and frequency of doses should be adjusted according to the
					 intensity, duration, impact of the pain, and treatment outcomes. Physician
					 assistants should recognize that tolerance and physical dependence are normal
					 consequences of sustained use of opioids and are not the same as opioid use
					 disorder.
The commission is obligated under the laws of the state of
					 Washington to protect the public health and safety. The commission recognizes
					 that the use of opioids for other than legitimate medical purposes poses a
					 threat to the individual and society. The inappropriate prescribing of
					 controlled substances, including opioids, may lead to drug diversion and abuse
					 by individuals who seek them for other than legitimate medical use.
					 Accordingly, the commission expects that physician assistants incorporate
					 safeguards into their practices to minimize the potential for the abuse and
					 diversion of controlled substances.
Physician assistants should not fear disciplinary action
					 from the commission for ordering, prescribing, dispensing or administering
					 controlled substances, including opioids, for a legitimate medical purpose and
					 in the course of professional practice. The commission will consider
					 prescribing, ordering, dispensing or administering controlled substances for
					 pain to be for a legitimate medical purpose if based on sound clinical
					 judgment. All such prescribing must be based on clear documentation of
					 unrelieved pain. To be within the usual course of professional practice, a
					 physician assistant-patient relationship must exist and the prescribing should
					 be based on a diagnosis and documentation of unrelieved pain. Compliance with
					 applicable state or federal law is required.
The commission will judge the validity of the physician
					 assistant's treatment of the patient based on available documentation, rather
					 than solely on the quantity and duration of medication administration. The goal
					 is to control the patient's pain while effectively addressing other aspects of
					 the patient's functioning, including physical, psychological, social, and
					 work-related factors.
These rules are designed to assist physician assistants in
					 providing appropriate medical care for patients.
The practice of medicine involves not only the science, but
					 also the art of dealing with the prevention, diagnosis, alleviation, and
					 treatment of disease. The variety and complexity of human conditions make it
					 impossible to always reach the most appropriate diagnosis or to predict with
					 certainty a particular response to treatment.
Therefore, it should be recognized that adherence to these
					 rules will not guarantee an accurate diagnosis or a successful outcome. The
					 sole purpose of these rules is to assist physician assistants in following a
					 reasonable course of action based on current knowledge, available resources,
					 and the needs of the patient to deliver effective and safe medical care.
For more specific best practices, the physician assistant
					 may refer to clinical practice guidelines including, but not limited to, those
					 produced by the agency medical directors' group, the Centers for Disease
					 Control and Prevention, or the Bree Collaborative.
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-918-800, filed 5/24/11, effective
						1/2/12.