Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-919 - Washington medical commission › OPIOID PRESCRIBING-GENERAL PROVISIONS › Section 246-919-850 - Intent and scope

Current through Register Vol. 24-14, July 15, 2024
The rules in WAC 246-919-850 through 246-919-985 govern
					 the prescribing of opioids in the treatment of pain.
The Washington state medical quality assurance commission
					 (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
					 nontreatment, 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 physicians to view pain
					 management as a part of quality medical practice for all patients with pain
					 including acute , perioperative, subacute, and chronic pain . All physicians
					 should become knowledgeable about assessing patients' pain and effective
					 methods of pain treatment, as well as become knowledgeable about the 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 uncertainty and to encourage better pain management.
Inappropriate pain treatment may result from a physician'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'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 , scientific research, and the use of pharmacologic and
					 nonpharmacologic modalities according to the judgment of the physician. 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. Physicians 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 physicians incorporate safeguards into
					 their practices to minimize the potential for the abuse and diversion of
					 controlled substances.
Physicians 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-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'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 physicians 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 physicians 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 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, §
						246-919-850, filed 5/24/11, effective
						1/2/12.