Bill to combat prescription abuse really will harm patients in pain

House Bill 2876, which sits on the desk of Washington's governor awaiting her signature, aims to reduce the serious and growing problem of prescription-drug abuse. However, the current legislation has little likelihood of improving this scourge and risks punishing the patients who need these medications and their physicians.

Major professional organizations with the perspective to make objective and fair-minded evaluations oppose it. In the interest of the public health, it is critical that policymakers create balanced solutions that prevent prescription-drug abuse without undermining responsible humane care of ongoing pain.

Key among concerns with HB 2876 is that it implements guidelines requiring a prescriber for any patient with chronic pain who needs a moderate to high dose of a strong painkiller called an opioid, to obtain consultation with a pain specialist. This means that if the bill were enacted today, many patients would unnecessarily suffer from severe but treatable pain.

The guideline that is the law's premise has been denounced by many leading medical organizations including the American Cancer Society, American Pain Society, American Academy of Pain Medicine, American Pain Foundation, American Society for Pain Management Nursing, and the Pain & Policy Studies Group at the University of Wisconsin. These groups argue it fails for several reasons:

• There are not enough pain specialists resulting in long delays while patients suffer and in many geographic areas consultations may not be available at all.

• Pain consultations are expensive and the bill does not address how they would be paid.

• The message to prescribers emphasizes getting help too late — after dosing has already gone up rather than applying risk management at the beginning of treatment.

• It imposes new liability concerns on physicians that will drive doctors from treating pain.

The combination of these issues will leave many patients to suffer with unnecessary pain and caregivers to defer pain management, ultimately resulting in greater socioeconomic burden and cost.

Equally troubling as a law doomed to failure is that Washington recently disbanded a system with proven success in capturing abusers of painkillers. Such Prescription Monitoring Programs (PMPs) exist in most other states and make data available to prescribers who can identify patients who may be abusing drugs before writing a new prescription.

PMPs allow doctors to treat legitimate pain patients while identifying those who go from doctor to doctor seeking prescriptions for illicit use.

It is important that Washington physicians are up-to-date in employing best practices for prescribing controlled substances and have ready access to prescription-management tools that help patients and address prescription-drug abuse. This however requires education and investment in programs like a PMP rather than laws that simply restrict practice.

Pain is the most common reason that people go to the doctor. Balance must be struck between the need to stop prescription-drug abuse and patients' legitimate need for pain relief. Washington must find that balance without harming legitimate pain patients or their doctors.

Simply put, Gov. Chris Gregoire should veto this bill so that patient care continues to be based on the patient's best interest.

Rather than legislating dubious restrictions, why not start with actions that prevent problems early in the process? State leaders should immediately support a PMP that helps physicians deter prescription abuse. All prescribers must be educated and supported to use safe risk management at the outset of treatment rather than restricting them once treatment has begun.

Effective solutions to prescription-drug abuse are critical to the public health but HB 2876 is a false "fix" at the expense of sound public-health policy and patients in pain.

Perry G. Fine, M.D., is president-elect of the American Academy of Pain Medicine; Scott M. Fishman, M.D., is president of the American Pain Foundation; and Seddon R. Savage, M.D., is president-elect of the American Pain Society.