Washington State Officials Offer Guidelines for Prescribing Narcotics

Washington state health officials have published new guidelines to help doctors evaluate and monitor dosage levels of narcotics prescribed to treat patients with chronic pain. The guidelines don't apply to the treatment of acute pain, cancer pain, or hospice care; they are part of a yearlong educational campaign sponsored by a panel of Washington state medical directors from six state agencies.

"The new guideline is an effort to improve patient care and safety,” said Dr. Gary Franklin, the Department of Labor and Industries' medical director and chairman of the Agency Medical Directors Group. L&I data shows there were 32 deaths among injured workers from 1996 to 2002 where an accidental overdose of prescription narcotics was confirmed. Deaths from this cause are rising statewide, too--up by more than 800 percent from 1995 to 2004. "Because prolonged, high-dose opioid therapy can be unsafe or can become less effective, we want to provide clear guidance in this area for primary-care providers," Franklin said.

The guidelines recommend a total daily dose of opioids should not exceed 120 milligrams of morphine or its equivalent if both pain and physical function are not improving. An online calculator helps doctors establish dosages of combinations of different opioids that stay within the guidelines. The guidelines and calculator are online at www.agencymeddirectors.wa.gov.

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