WA State condemns inappropriate treatment of pain

Finally, some good news: the State of Washington has issued an “Interpretive Statement” to officially condemn doctors unwilling to effectively treat pain, even when that includes opioid therapy, and to clarify that:

appropriate pain management is the responsibility of the treating practitioner and the inappropriate treatment of pain, including lack of treatment, is a departure from the standard of care.”

This is a complete turn-around from the stringent restrictions this state was one of the first to enact. Jane Ballantyne, MD, and Roger Chou, MD, two of the “experts” who worked on the CDC guideline, are both from the University of Washington, so I’m astonished that the same state is now backing off from their extreme anti-opioid views.

Will wonders never cease…

State of Washington – Washington Medical Commission Interpretive Statement

Description of the Issue

The Washington Medical Commission (Commission) is aware that some practitioners are refusing to see or continue to treat patients who have taken or are currently using opioids.

To help underscore and clarify the need for patient access and the rights of patients for treatment, the Commission issues this interpretive statement for patient and practitioner use.

Interpretive Statement

The opioid prescribing rule states that:

“appropriate pain management is the responsibility of the treating practitioner and the inappropriate treatment of pain, including lack of treatment, is a departure from the standard of care.”

The Commission, in WAC 246-919-850 and WAC 246-918- 800 encourages practitioners, especially those in primary care, to view pain management as a part of standard medical practice for all patients and to become knowledgeable about assessing pain and effective treatments.

The intent provision explicitly states that the rules are not inflexible and repeatedly recognizes the importance of clinical judgment.

The Commission interprets WAC 246-919-850 to 246-919-985 and corresponding physician assistant Washington Administrative Code (WAC 246-918-800 to WAC 246-918-935) as encouragement to practitioners to not exclude, undertreat, or dismiss a patient from a practice solely because the patient has used or is using opioids in the course of normal medical care.

While in most circumstances a practitioner is not legally required to treat a particular patient, the refusal to see or continue to treat a patient merely because the patient has taken or is currently using opioids is contrary to the clear intent of the Commission’s rules governing opioid prescribing.

Ending opioid therapy or initiating a forced tapering of opioids to a particular MED level for reasons outside of clinical efficacy or improvement in quality of life and/or function or abuse would violate the intent of the rules.


The new rule, WAC 246-919-850, and its corresponding physician assistant rule (WAC 246-918- 800), describe the Commission’s intent and scope of the rules as follows:

“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. …

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 [practitioners] 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.”

You can read the full document at https://www.dropbox.com/s/xf2er5kdncmf74r/Opioid-PatientsINS2019-02.pdf?dl=0

5 thoughts on “WA State condemns inappropriate treatment of pain

  1. Minion

    Wow. What a day. They announced today that recreational pot will be legal in Illinois January 1st, 2020.
    THC makes me paranoid, so for me it means no more people being imprisoned over a flipping plant!
    And I way prefer my local criminals high on pot rather than alcohol or meth.
    WE LOST THE DRUG WAR, mmmkay?
    They are releasing all prisoners convicted of misdemeanors asap. WE GOT POT for yall to harvest if you cannot find a good job!
    It’s a banner day for freedom here in Chicago.
    I did smoke my first CBD joint last week. There was a slight miracle the next morning, but I have to conduct further studies to be sure it really worked on my arthritis pain.

    Liked by 2 people

    1. Zyp Czyk Post author

      It really looks like the tide is turning, but actually getting necessary pain medication back to pain patients might still take quite a while. I just hope that those who are already contemplating suicide can hang on long enough…


  2. peter jasz

    RE: ….to officially condemn doctors unwilling to effectively treat pain, even when that includes opioid therapy …”

    Condemns ? It does nothing of the sort -it simply states that failure to act on the patients behalf would represent less than optimal standards of care,

    ” …effectively treat pain, even when that includes opioid therapy …”

    Opiate’s ARE THE ONLY EFFECTIVE (pharmacological) treatment for moderate-severe pain.
    (sk the millions who were “started” on BS alternatives Gabapoison, Anti-inflammatory and a shit-load of other crap med’s that does nothing but make doctor’s/pharmaceuticals boat-loads of money.




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