Subject of Possible Rule Making: Physicians and physician assistants general provision for opioid prescribing and tapering rules. The Washington medical commission (commission) is considering amending the following rules to modernize the language, add clarity, and bring the rules more in line with current practice: WAC 246-918-801 (physician assistants) Exclusions, 246-918-845 (physician assistants) Patient evaluation and patient record—Subacute pain, 246-918-855 (physician assistants) Patient evaluation and patient record—Chronic pain, 246-918-870 (physician assistants) Periodic review—Chronic pain, 246-918-900 (physician assistants) Tapering considerations—Chronic pain, 246-919-851 (physicians) Exclusions, 246-919-895 (physicians) Patient evaluation and patient record—Subacute pain, 246-919-905 (physicians) Patient evaluation and patient record—Chronic pain, 246-919-920 (physicians) Periodic review—Chronic pain, and 246-919-950 (physicians) Tapering considerations—Chronic pain. The commission is considering amending these WAC to modernize the language, add clarity, and bring the rules more in line with current practice.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: On November 3, 2022, the Center for Disease Control and Prevention (CDC) released an update to their 2016 "Clinical Practice Guideline for Prescribing Opioids for Chronic Pain", entitled "CDC Clinical Practice Guideline for Prescribing Opioids for Pain" (guideline). The guideline expands its scope to include opioid prescribing for all pain (with certain exemptions). As such, the guideline more closely parallels the Washington state opioid prescribing rules developed in 2017-2018 and implemented in January of 2019, mandated by ESHB 1427 (chapter 297, Laws of 2017), and covering all Washington state opioid prescriber groups, including all allopathic physicians and physician assistants overseen by the commission. However, there are some differences.

The commission contracted with Gregory Terman, MD, who is a former pro tempore commissioner of the commission as well as a professor of anesthesiology and pain medicine at the University of Washington in Seattle, to do a comprehensive comparison of the commission's opioid prescribing rules covering physicians (WAC 246-919-850 through 246-919-990) and physician assistants (WAC 246-918-800 through 246-918-835) to the guideline. Dr. Terman was also asked to recommend changes to the commission's opioid prescribing rules based on the differences found between the commission's opioid prescribing rules and the guideline. Dr. Terman provided the commission with a report titled "Comparing and Contrasting the 2022 CDC Opioid Prescribing Guideline and the 2019 Washington State Prescribing Rules" (report). Based on the recommendations in the report, the commissioners voted to initiate rule making on the following items:

Rules on this subject may be needed to allow patients with sickle cell disease to receive the care they need in an efficient manner, provide physicians and physician assistants with more clarity on when and how to taper patients to whom they prescribe opioids for chronic pain, and provide rules that address how to work with patients that have an aberrant biological specimen test.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Amelia Boyd, Program Manager, P.O. Box 47866, Olympia, WA 98504-7866, phone 360-918-6336, TTY 711, email amelia.boyd@wmc.wa.gov, website https://wmc.wa.gov.