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The Oregon Medical Board has begun giving doctors more leeway to prescribe high doses of opioid painkillers, following a yearslong crackdown on the practice after aggressive marketing by manufacturers and subsequent overprescribing by doctors led to a nationwide epidemic of opioid addiction.
But the medical board now concedes the crackdown had undesirable consequences of its own. “The board is well aware some number of clinicians have shied away from long-term pain management in part or in whole for fear of board sanctions. We wish it weren’t so,” wrote the board’s medical director, David Farris, in a newsletter distributed March 4.
The board has the power to suspend or even take away medical licenses, although it rarely uses that authority and prefers to impose temporary limitations on doctors’ practices. Still, doctors fear scrutiny by the board, and its policies therefore carry significant weight. “Careers have died,” noted Farris in the newsletter.
The medical board first outlined its “updated stance” in early January, when it amended a “statement of philosophy” on pain management posted on its website. The new statement eliminates prior guidelines on maximum dosages for treating chronic pain, although it doesn’t relieve doctors of the responsibility to weigh “the risks versus benefits of opioid treatment for chronic pain”—and the expectation that they check state databases to ensure patients aren’t doctor-shopping to feed an addiction.
Until this year, the board’s pain management policy mandated that doctors limit opioid prescriptions to a “50 Morphine Equivalent Dose” when treating acute pain. That number is now gone. “Prescribers should conduct a patient-centered evaluation when determining appropriate Morphine Equivalent Dose (MED) limitations for each unique patient,” the current statement says.
It comes on the heels of new “clinical practice guidelines” from the U.S. Centers for Disease Control and Prevention in 2022, which noted concerns that “some policies purportedly drawn from [2016 guidelines] have been notably inconsistent with it and have gone well beyond its clinical recommendations,” including “rapid opioid tapers and abrupt discontinuation without collaboration with patients.”
Oregon policymakers took note. “Gone is the requirement to rapidly taper or discontinue opioids for patients on high doses,” Farris noted, referring to the state’s new pain prescribing standards in his Monday column.
A WW cover story earlier this year profiled one of the doctors who was caught up in the OMB crackdown. Dr. Darrell Brett was doling out painkillers so liberally it crossed over into negligence, the board found, while also failing to check a state database to determine whether patients were getting the drugs from other doctors, too.
As WW noted in that story, Oregon maintains a database of opioid prescriptions that doctors can use to check the amount of opioids patients are being given—and that regulators could check to find problematic prescribers. At least, in theory. As WW reported this year, state law prevents regulators from accessing the database until they receive a complaint, and unlike in many other states, doctors aren’t required by law to check it (although the medical board says it “expects” them to.)
A decade ago, WW examined the effects of the prescription opiate epidemic on the Oregon Coast town of Wheeler.