Pain Relief Network Sues State of Washington

The nonprofit Pain Relief Network says the guidelines for prescribing narcotics, written by the Washington state Department of Health and published in March 2007, have influenced pain treatment across the country and have made doctors afraid to give opiate prescriptions.

Siobhan Reynolds, president of the Pain Relief Network, says the group decided to target Washington because the state has been a leader both in pain treatment and in restricting doctors’ prescriptions of pain relief medication.

The guidelines, which apply only to treatment of chronic pain, not acute pain, cancer pain or hospice care, 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.

Reynolds said such guidelines do not take into account the needs of individuals and make doctors afraid to give larger doses when necessary.

Laura D. Cooper, a Eugene, Ore., attorney representing Dr. Merle Janes, a board-certified pain specialist, and a (class action) group of Washington residents being treated for pain, compared the prescription guidelines to setting a limit on how much insulin a diabetic could be prescribed.

Although the guidelines apply only to Washington state, they have been used by insurance companies, prisons, worker’s compensation boards and other agencies all over the country as a starting point for their own rules, Cooper said, claiming that Washington’s guidelines have become defacto regulations across the nation.

The lawsuit offers several legal arguments, based on civil rights laws, the Americans With Disabilities Act, and other federal and state laws. It contends Washington’s guidelines violate both state and federal law and should be changed or discarded.

The Washington state attorney general’s office was unable to comment on the lawsuit Wednesday because the lawyers on staff had yet reviewed the case, spokeswoman Janelle Guthrie said.

The medical directors from six state agencies wrote the guidelines as the Agency Medical Directors Group. They are all named in the lawsuit as representatives of their agencies.

Dr. Gary Franklin, chairman of the group and medical director of the state Department of Labor and Industries, explained at the time the guidelines were issued that they were the state’s effort to improve patient care and safety.

Franklin, who is one of the doctors named in the suit, said in a news release there were 32 deaths among injured workers where an accidental overdose of prescription opioids was confirmed between 1996 and 2002.

“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.

Reynolds said the guidelines set the interests of ill people against the self-preservation interests of doctors.

“The ramifications are enormous,” Reynolds said. “You never see on a death certificate that people died of pain, but people die of pain all the time.”

This is the Pain Relief Network’s first lawsuit against a state; previous efforts have focused on defending doctors in criminal cases, Reynolds said. The network considers itself Internet-based, and its lawyers are from various states, she added.