Chronic Pain Rules Group Hears About Opioid Dosing Guidelines in Washington State

Gary Franklin, MD, MPH, medical director for the Washington State Department of Labor and Industries, joined the State Medical Board of Ohio’s Chronic Pain Rules Workgroup at its conference call meeting on May 16.

Dr. Franklin is an advocate for guidelines that include a “yellow flag” warning opioid dose threshold of 120 mg/day morphine-equivalent dose.

Washington state’s guideline recommends that prescribing physicians and other health care providers obtain consultation from a pain medicine expert for patients with chronic, non-cancer pain receiving opioid doses greater than 120 mg/day morphine-equivalent dose. This is for pateints whose pain and function has not substantially improved during opioid treatment, and is to be done before continuing to prescribe daily doses above 120 mg morphine-equivalent dose. Dr. Franklin refers to this as “stopping to take a breath before moving forward.”

Dr. Franklin has assessed changes in opioid dosing patterns and opioid-related mortality in Washington state’s workers compensation system and has concluded that the opioid dosing guideline appears to be associated temporally with a decline in doses for long-acting opioids and in the number of opioid-related deaths among injured workers (injured workers receiving benefits through the workers’ compensation system).

Questions asked of Dr. Franklin included:
  • How did the Washington state data account for deaths that had other substances involved such as alcohol and cocaine?
  • How is the patient’s metabolism accounted for?
  • Is the Bureau of Workers Compensation (BWC) the proper forum to evaluate opioid dosing thresholds as most pain patients are not BWC patients?
  • Diversion vs. scripts – which is the bigger issue?

The Kasich Administration has been particularly interested in using Washington state’s experience as a model for what might be done here in Ohio.

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