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 246-918-802 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The definitions apply to WAC
					 246-918-800
					 through 246-918-935 unless the context clearly requires otherwise.
(1) "Aberrant behavior" means behavior that
				  indicates current misuse, diversion, unauthorized use of alcohol or other
				  controlled substances, or multiple early refills (renewals).
(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 of 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)
				  "Cancer-related pain" means pain that is an unpleasant, persistent, subjective
				  sensory and emotional experience associated with actual or potential tissue
				  injury or damage or described in such terms and is related to cancer or cancer
				  treatment that interferes with usual functioning.
(5) "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. Chronic pain is considered to be pain that persists for more than twelve
				  weeks.
(6) "Comorbidities" means a
				  preexisting or coexisting physical or psychiatric disease or
				  condition.
(7) "Designee" means a
				  licensed health care practitioner authorized by a prescriber to request and
				  receive prescription monitoring program (PMP) data on their behalf.
(8) "Episodic care" means noncontinuing
				  medical or dental care provided by a physician assistant other than the
				  designated primary prescriber for a patient with chronic pain.
(9) "High dose" means a ninety milligram
				  morphine equivalent dose (MED), or more, per day.
(10) "High-risk" is a category of patient at
				  high risk of opioid-induced morbidity or mortality, based on factors and
				  combinations of factors such as medical and behavioral comorbidities,
				  polypharmacy, current substance use disorder or abuse, aberrant behavior, dose
				  of opioids, or the use of any concurrent central nervous system
				  depressant.
(11) "Hospice" means a
				  model of care that focuses on relieving symptoms and supporting patients with a
				  life expectancy of six months or less.
(12) "Hospital" as defined in chapters 70.41,
				  71.12 RCW, and
				  RCW
				  72.23.020.
(13) "Low-risk" is 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 a fifty milligram morphine
				  equivalent dose per day.
(14)
				  "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.
(15) "Moderate-risk" is 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 fifty to ninety milligram morphine
				  equivalent doses per day.
(16)
				  "Morphine equivalent dose" or "MED" means a conversion of various opioids to a
				  morphine equivalent dose using the agency medical directors group or other
				  conversion table approved by the commission. MED is considered the same as
				  morphine milligram equivalent or MME.
(17) "Multidisciplinary pain clinic" means a
				  health care delivery facility staffed by physicians of different specialties
				  and other nonphysician health care providers who specialize in the diagnosis
				  and management of patients with chronic pain.
(18) "Opioid" means a drug that is either an
				  opiate that is derived from the opium poppy or opiate-like that is a
				  semi-synthetic or synthetic drug. Examples include morphine, codeine,
				  hydrocodone, oxycodone, fentanyl, meperidine, tramadol, buprenorphine, and
				  methadone when used to treat pain.
(19) "Palliative care" means care that
				  maintains or improves the quality of life of patients and their families facing
				  serious, advanced, or life-threatening illness.
(20) "Perioperative pain" means acute pain
				  that occurs surrounding the performance of surgery.
(21) "Prescription monitoring program" or
				  "PMP" means the Washington state prescription monitoring program authorized
				  under chapter 70.225 RCW. Other jurisdictions may refer to this as the
				  prescription drug monitoring program or PDMP.
(22) "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 podiatric physician licensed under chapter 18.22 RCW.
(23) "Refill" or "renewal" means a second or
				  subsequent filling of a previously issued prescription.
(24) "Subacute pain" is considered to be a
				  continuation of pain that is six to twelve weeks in duration.
(25) "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 is a
				  normal physiological consequence 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.
Statutory Authority:
						RCW
						18.71.450,
						18.71A.100,
						18.71.017, and
						18.71A.020. 11-12-025, §
						246-918-802, filed 5/24/11, effective
						1/2/12.