Monday, June 22, 2015

OMB Policy Statement: Pain Management

The following is the Policy Statement Pain Management created by the Oregon Medical Board (OMB).  The OMB licenses doctors in Oregon.

"Pain Management
The OMB urges the skillful use of effective pain control for all patients.  It is important for providers to be well-informed on relevant pain management techniques and hone their skills for the optimal treatment of their patients, taking into account the etiology of the pain.  Types of pain include, but are not limited to, acute post-operative or traumatic pain, chronic non-cancer pain, chronic pain caused by malignancies and pain associated with terminal illness.  Providers are encouraged to treat pain within the scope of their practice and refer patients to the appropriate specialists when indicated.

Acute Pain

Effective treatment of acute pain promotes recovery and return to normal function.  The potential for addiction is low when short courses of opioids are used to treat acute pain and discontinued as the patient recovers.  Inadequately managed acute pain may result in chronic pain.  Patients who are not recovering as expected must be carefully assessed. Skillful pain management techniques including oral, parenteral and, when available, regional pain management techniques, can achieve maximum patient comfort and may reduce the need for opioids.

Chronic Pain

Patients with chronic pain require complex care and treatment decisions for multi-faceted problems. Providers have a responsibility to diagnose and manage chronic pain while maximizing the benefits and minimizing the potential adverse effects of treatment.  Opioids are not always required or effective for the treatment of chronic pain, and they should be discontinued if the patient’s pain control or function does not improve with their use.

Pain management treatment must be evidence-based and individualized to the patient. Oregon statute protects providers from disciplinary action by the Board when prescribing or administering controlled substances as part of a treatment plan for pain with the goal of controlling the patient’s pain for the duration of the pain.  However, prescribing controlled substances without a legitimate medical purpose is prohibited.

Patient safety should be a key factor in determining a treatment plan for pain management.  When the provider prescribes opioids as part of the treatment plan, the provider must consider drug safety, efficacy and treatment goals for the patient.  Safe opioid prescribing requires knowledge of the pharmacology of various opioid classes, and of potential drug interactions.  Opioids are most likely to be successful in reducing pain and restoring function when they are combined with other pain management approaches such as physical therapy and psychological techniques.

When prescribing opioids for chronic pain, Oregon law requires practitioners to provide careful assessment and documentation of the medical condition causing pain as well as co-morbid medical and mental health conditions.  Goals for treatment should be established with the patient before prescribing opioids. The provider’s assessment, diagnosis and discussion must be documented in the patient record.  The diagnosis, drugs used, goals, alternatives, and side effects must be included in a signed document demonstrating consent and understanding of the treatment plan and its risks.  A sample document may be found here​.   In addition to the signed informed consent document, a written patient-provider agreement is recommended for patients requiring opioids for chronic pain. In all cases of pain management, practitioners should maintain records to track prescriptions and coordinate care with other treating practitioners.

The OMB recommends enrollment and participation in the Oregon Prescription Drug Monitoring Program (PDMP), a division of the Oregon Health Authority, to help guide treatment plans.  The PDMP is a database that allows prescribers of controlled substances to access a patient’s name, the controlled substance prescribed, the dosage, and the name and contact information of the prescriber.

Terminal Illness

The OMB believes that physicians should make every effort to relieve the pain and suffering of their terminally ill patients. Patients nearing the end of their lives should receive sufficient opioid dosages to produce comfort.  The physician should acknowledge that the natural dying process usually involves declining blood pressures, decreasing respirations and altered levels of consciousness.  Opioids should not be withheld on the basis of physiologic parameters when patients continue to experience pain.

Some physicians express concerns that the use of opioids in these patients may hasten death through pneumonia or respiratory depression.  For these reasons, at times physicians may have limited the use of opioids in dying patients out of fear that they may be investigated for inappropriate prescribing or allegations of euthanasia.

The OMB is concerned that such fear on the part of physicians may result in inadequate pain control and unnecessary suffering in terminally ill patients.  The OMB encourages physicians to employ skillful and compassionate pain control for patients near the end of life and believes that relief from suffering remains the physician’s primary obligation to these patients.

- Adopted January 1993
- Amended April 1999
- Amended July 2004
- Amended April 2011
- Amended January 2013"

OMB Pain Management Policy Statement

Medical Marijuana & Opioid OMB Statement

The following statement is the current position of the Oregon Medical Board (OMB), which license doctors in this state.  It is clear that they do not prevent doctors from prescribing opioid pain medication to people who are also using marijuana.

"Medical Marijuana

The Oregon Medical Marijuana Program is administered by the Oregon Health Authority. The relevant Oregon Revised Statutes are 475.300 through 475.346 and the Oregon Administrative Rules are 333-0008-0000 through 333-008-0120. The Oregon Health Authority’s website on the Oregon Medical Marijuana Program provides additional program information and contact information.

The Oregon Medical Board does not oversee or otherwise regulate the Oregon Medical Marijuana Program.

The Board does not currently have a rule or a policy position on prescribing opioids to patients with a medical marijuana card.  While the Board’s consultants have included the use of marijuana among the list of contraindications for long-term opioid use, the Board has not prohibited the concurrent use of these drugs.

Prescribing practices do come to the Board’s attention, and every written complaint is investigated as required by statute.  The Board does not discipline physicians solely based on certifying patients for the use of medical marijuana, prescribing opioids to a known medical marijuana patient, or creating treatment plans that include the concurrent use of opioids and medical marijuana.  However, if an investigation into a complaint showed inappropriate practices or unprofessional conduct by any physician, the Board would take action for any violations of the Medical Practice Act that are found.

The Board will continue its attention to this evolving area of medicine.  Any updated policies created by the Board will be available on our website.  We appreciate the public interest in this important issue and its impact on the safety of Oregon patients"

Link to Oregon Medical Board (OMB) Statement

Wednesday, April 1, 2015

Patients' Right to Rest Supported by Oregon Patients Rights Association

Although there are many bills in the state legislature that deserve support, Oregon Patients Rights Association (OPRA)  only has time, energy and other resources to make  recommendations about a few.   One of the bills being considered may not seem to have anything to do with healthcare but it does.  Our position paper, The Right to Rest, explains why.   Click on the follow link to read it.

Tuesday, March 24, 2015

Make Health Care Agenda Part of Local Town Halls!

There are several bills in the state legislature that Oregon Patients Rights Association (OPRA) is following and support.   Friday local healthcare consumers will have the opportunity to ask our local state representatives what they are doing to protect patients' rights during this legislative session.   

For information about each bill that is part Oregon Patients Rights (OPRA) Legislative Agenda, please check out the links provided.

Jeff Kruse is on the Senate's Committee on Health Care , where most of these bills are currently being considered.   It is particularly important to ask Kruse to support OPRA's legislative agenda, which includes making non-profit hospitals and Coordinated Care Organizations (CCO) more accountable.  

Even if you can't make it to one of these meetings, you can email or call your state representatives to let them know your opinion.  

The following was sent out by State Senator Jeff Kruse regarding the upcoming Town Halls in Douglas County.

Rep. Dallas Heard And Sen. Jeff Kruse To Hold Series Of Town Halls
Forums Will Take Place In Roseburg, Winston And Myrtle Creek

Salem, OR – Representative Dallas Heard (R-Winston) and Senator Jeff Kruse (R-Roseburg) will host a series of town halls on Friday, March 27, 2015, to provide an overview of the 2015 legislative session and address constituent questions and concerns.

“Senator Kruse and I are excited to have the chance to meet with our constituents and provide an update on the legislative session,” said Rep. Heard. “We look forward to having the critical opportunity to hear directly from the people we represent in Salem. ”

The forums are open to the public and all residents are encouraged to attend. For more information, please contact Rep. Heard’s office at 503-986-1402 or

Friday, March 27, 2015

Roseburg Town Hall Meeting

WHEN:             9:00 a.m.

WHERE:           Roseburg City Hall
City Council Chambers
                        900 SE Douglas Ave
                        Roseburg, OR 97470

Winston Town Hall Meeting

WHEN:             12:00 p.m.

WHERE:           Winston City Hall
City Council Chambers
                        210 NW Douglas Blvd.
                        Winston, OR 97496

Myrtle Creek Town Hall Meeting

WHEN:             3:00 p.m.

WHERE            Myrtle Creek Community Center
                        425 NW 2nd Street
                        Myrtle Creek, OR 97457


If you are interested in reading my past newsletters please click on my webpage link below:

Monday, March 16, 2015

Public Health is a Patients' Rights Issue!

Tonight, Douglas County Commissioners will hold the first of two public meetings regarding the future of public health services in our community.   Although Oregon Patients Rights Association (OPRA) does not focus on public health services,  these services are an important patients' rights issue.

Our county commissioners want to get out of the public health business.  However a push back by the community last year made sure that it was not going to be done quickly.  It was the community outcry that happened then that made sure there would be better opportunities for public information and input.  Tonight is one of those opportunities for you to take advantage of,  we encourage you to do so.  

What:       Douglas County Public Health Meetings

When:      1st Meeting

Monday, March 16, 2015
5:30 pm
Douglas County Library, 

                 2nd Meeting
Tuesday, March 31, 2015

Unfortunately , like all taxpayer funded services, your rights as a consumer are reduced when someone other than a government runs a program.   This will be no different if public health services are contracted out to private (either profit or non-profit) entities.  We should move slowing and carefully regarding any changes about who is responsible for public health in Douglas County.

Monday, December 15, 2014

Happy PATIENT’S Bill of Rights Day!

Okay there is really no official document or law called the Patient’s Bill of Rights and there is no special day celebrating its existence.  However, today is Bill of Rights Day 2014, which is officially recognized by the United States government.  December 15th marks the day in 1791 when the first ten amendments to the US Constitution were ratified.  Although these rights did not say they applied to health care and patients, it is because of the rights established in that document that we have rights as patients today. 

Although there is no one document that spells out the rights patients have regarding health care, it is through government programs and regulations that some of the basic rights we have as citizens extend to the health care services we receive.  This is particularly clear when we receive our health care services from or paid for by the federal government. 

In 1998 President Bill Clinton directed various federal agencies to use their authority to bring health care programs in line with a basic Patient’s Bill of Rights.

According the US Department of Health and Human Services (HHS) Archives, “The Patients' Bill of Rights and Responsibilities has three goals: to strengthen consumer confidence that the health care system is fair and responsive to consumer needs; to reaffirm the importance of a strong relationship between patients and their health care providers; and to reaffirm the critical role consumers play in safeguarding their own health.”

The Patient’s Bill of Rights and Responsibilities set out the right to:

·         Informed Choice
·         Access Emergency Services
·         Full Partnership in Health Care Decisions
o   When cannot do for self; right to be represented by others.
·         Care Without Discrimination
·         Privacy 
·         Speedy Complaint Resolution

By looking at the above, can you make connections with the Bill of Rights or other aspects of the U.S. Constitution or other laws?