Treating pain must survive crackdown on opioid abuse

From the editorial board

Living with chronic pain is fraught with plenty of challenges — on some days, simply getting out of bed — without accounting for the regulatory hurdles patients must jump over while seeking a modicum of relief from their misery.

The unsettled landscape of pain treatment in Washington state extends into all communities and countless health conditions. It can affect the person trying to recover from the acute pain of an automobile or workplace accident as surely as those coping with long-term afflictions such as multiple sclerosis and fibromyalgia.

Two news stories in the last several days underscore the need for serious dialogue among state leaders about how to improve pain management. At stake is the quality of life for tens of thousands of Washingtonians diagnosed with legitimate conditions that cause chronic pain.

The first story was the license suspension of the doctor who runs Seattle Pain Centers, a network of eight clinics including one in Tacoma. Dr. Frank D. Li was shut down by the state last week pending an investigation into possible Medicaid fraud and the deaths of at least 18 patients over five years. Federal officials are taking a separate look at Li, concerned that he ran a pill mill in which opiates were overprescribed.

The second story, published in The News Tribune last weekend, documented the disarray in Washington’s marijuana bureaucracy as the state makes the transition to a combined medical and recreational pot system. TNT staff writer Craig Sailor reported many retailers lack the medical certifications they need to serve patients, are confused about state rules and have no medically compliant cannabis products to sell.

In both stories, people who take drugs to control pain are running up against officials doing their jobs to enforce reasonable public policy. The state Liquor and Cannabis Board, for example, must ensure recreational users don’t exploit the tax-free savings and higher-dosage products available to medical users.

Meanwhile, state and federal authorities have adopted an understandably aggressive response to the national opioid crisis. In March, President Obama proposed spending $1.1 billion next year to address painkiller addiction. Local numbers released last week by the Tacoma-Pierce County Health Department offer a sobering glimpse of the epidemic: 704 people died from overdoses between 2005-2014 (includes prescription opiates and their illicit twin, heroin), while drug treatment admissions have steadily climbed (the number of first-timers seeking treatment more than tripled from 2002 to 2015).

Alarming as these statistics are, however, the majority of people who suffer chronic pain are neither oxycodone junkies nor pot heads. And while the war on addictive drugs must be fought, society can’t turn its back on the casualties.

There are thousands of people who need support — an estimated 25,000 patients served by Dr. Li alone, now cast adrift — as the state lurches forward in the emergent field of pain management.

Help should come in the form of insurance coverage and incentives for alternative treatments, such as physical therapy, steroid injections and acupuncture. It should come from expanded education and support groups, such as the Pain Society of Washington.

It certainly needs to come through the training of more pain specialists, especially in rural areas. The state Department of Health acknowledges a shortage of physicians certified to consult with patients. In 2010, the Legislature passed a law requiring a pain specialist consultation before above-normal opiate dosages can be prescribed.

America’s pain predicament is a two-headed monster: too many addictive pharmaceuticals dispensed, and too few options for people caught in the jaws of life-altering discomfort. Continuing to attack one head of the beast, while ignoring the other, would be a tragedy.