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Managing Pain

The Washington State Department of Health provides a dashboard to view data on Opioid prescribing by county or Accountable Communities of Health (ACHs). Bree measures included on the dashboard are:

  • Patients prescribed any opioid, by age group
  • Patients prescribed chronic opioids, all age groups
  • Patient prescribed high dose chronic opioids, 50+/90+/120+ MME/days per quarter
  • Patients prescribed any opioids and sedatives
  • Days supply of patients prescribed opioids, by youth or adult – 0-3 days, 4-7 days, 8-13 days and 14+ days
  • New opioid patient with chronic opioids
  • All patients with any opioid use disorder treatment formulary

The Washington State Department of Health also tracks prescription opioid deaths by age group, Industry of employment, Race and Ethnicity, Sex Assigned at birth, SOGI, Veterans status, and county. Their dashboard can be found here.

Collaborative Care for Chronic Pain

Read our Reports and Recommendations

(Adopted January 2019)

Read our Summary

Treatment of pain varies widely between systems and clinicians with high financial and human cost. Moving to a collaborative or team-based approach to managing complex pain has been shown to result in better patient outcomes. However, most approaches to pain management including chronic opioid therapy involved siloed health care providers. This workgroup met from January 2018 to January 2019, focused on a biopsychosocial model within primary care for patients with chronic pain with life activity impacts, and defined minimum standards for:

  • Patient identification and population management
  • A care team
  • A care management function
  • Basing treatments in evidence
  • Patient-centered supported self-management

Supporting Materials

Letter from the Health Care Authority Accepting the Collaborative Care for Chronic Pain Recommendations
Collaborative Care for Chronic Pain Workgroup Charter and Roster

.Workgroup Members

Name Title Organization
Leah Hole-Marshall, JD (chair) Counsel and Chief Strategist Washington Health Benefit Exchange
Ross Bethel, MD Physician Selah Family Medicine
LuAnn Chen, MD, MHA, FAAFP Medical Director Community Health Plan of Washington
Lynn DeBar, PhD, MPH Senior Investigator Kaiser Permanente Washington Health Research Institute
Stuart Freed MD Chief Medical Officer Confluence Health
Andrew Friedman, MD Physiatrist Virginia Mason Medical Center
Mark Murphy, MD President Washington Society of Addiction Medicine
Mary Kay O’Neill, MD, MBA Partner Mercer
Jim Rivard, PT, DPT, MOMT, OCS, FAAOMPT President MTI Physical Therapy
Kari A. Stephens, PhD Assistant Professor – Psychiatry & Behavioral Sciences University of Washington Medicine
Mark Sullivan, MD, PhD Professor, psychiatry; Adjunct professor, anesthesiology and pain medicine University of Washington Medicine
Nancy Tietje Patient Advocate
Emily Transue, MD, MHA Associate Medical Director Washington State Health Care Authority
Michael Von Korff, ScD Senior Investigator Kaiser Permanente Washington Health Research Institute

Dental Opioid Prescribing

Award winners for Best Practices in Dental Opioid Prescribing:

Read our Report and Recommendations

(Adopted September 2017)

The Washington State Agency Medical Directors Group (AMDG) developed a comprehensive Guideline on Prescribing Opioids for Pain in June 2015. The Guidelines were subsequently adopted by the Bree Collaborative at the July 2015 meeting. This workgroup will design and carry out strategies to implement the Guidelines. This workgroup met from December 2015 to April 2020.

Supporting Materials

Letter from the HCA Accepting Dental Prescribing Guidelines
Opioid Guideline Implementation Charter
Agency Medical Directors Group Interagency Guideline on Prescribing Opioids for Pain
AMDG Guideline Summary

Workgroup Members

Name Title Organization
Chris Baumgartner Director Prescription Monitoring Program Washington State Department of Health
David Buchholz, MD Medical Director Premera Blue Cross
Rolf Christensen, DDS Dental Urgent Care Clinic Director University of Washington School of Dentistry
Tom Dodson, DMD, MPH Professor & Chair, Oral and Maxillofacial Surgery University of Washington School of Dentistry
Gary Franklin, MD, MPH (Chair) Medical Director Washington State Department of Labor and Industries
Charissa Fontinos, MD Deputy Chief Medical Officer Washington State Health Care Authority
Bea Gandara, DDS Professor University of Washington School of Dentistry
Frances Gough, MD Chief Medical Officer Molina Healthcare
Dan Kent, MD Chief Medical Officer UnitedHealthcare
Kathy Lofy, MD Chief Science Officer Washington State Department of Health
Jaymie Mai, PharmD Pharmacy Manager Washington State Department of Labor and Industries
Theresa Madden, DDS, MS, PhD Fellow International College of Dentists
Ron Marsh, DDS Member Washington State Dental
Quality Assurance Commission
Mellani McAleenan, JD Director of Government Relations Washington State Dental Association
Shirley Reitz, PharmD ‎Clinical Pharmacist Client Manager OmedaRx, Cambia
Gregory Rudolph, MD Addiction Medicine Swedish Pain Services
Mark Stephens President Change Management Consulting
David Tauben, MD Chief of Pain Medicine University of Washington Medical Center
Gregory Terman MD, PhD Professor Department of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology and Behavior, University of Washington
Michael Von Korff, ScD Senior Investigator Kaiser Permanente Washington Research Institute

Lower Back Pain

Award winners for Best Practices in Low Back Pain Treatment

Read our Guidelines

(Adopted November 2013)

Read our Revised Spine COAP Recommendations

(Adopted March 2013)

Low back pain is a major concern for many Washington State residents and their employers. We prioritized spine/low back pain in September 2011 through a two-step approach:

  • Forming a workgroup to develop recommendations for preventing the transition of acute pain to chronic pain and disability.
  • Recommending that all hospitals participate in the Spine Surgical Care and Outcomes Assessment Program (SCOAP) to improve surgical outcomes for chronic low back pain patients. SCOAP is a provider-led program of the Foundation for Health Care Quality that collects data on select surgical procedures for quality improvement.

The workgroup met from November 2012 to October 2013 to develop recommendations including increasing:

  • Appropriate evaluation and management of patients with newly diagnosed and persistent acute low back pain and/or nonspecific low back pain not associated with major trauma in primary care.
  • Early identification and management of patients diagnosed with low back pain that is not associated with major trauma but have psychosocial factors (e.g., anxiety) that place them at a high risk for developing chronic low back pain and disability.
  • Awareness of low back pain management among individual patients and the general public.

Supporting Materials

Letter from Health Care Authority Accepting TKR/THR Bundle, Warranty, and Spine Report
Public Comments Summary: Spine/Low Back Pain Report and Recommendations
Original Spine SCOAP Recommendation to HCA (Adopted January 2013)
Workgroup Charter
Letter from Health Care Authority Accepting Spine SCOAP and Cardiology Recommendations

Workgroup Members

Member Title Organization
Dan Brzusek, DO Physiatrist Northwest Rehab Association
Neil Chasan Physical Therapist Sport Reaction Center
Andrew Friedman, MD Physiatrist Virginia Mason
Leah Hole-Curry, JD Medical Administrator WA State Labor & Industries
Heather Kroll, MD Rehab Physician Rehab Institute of Washington
Chong Lee, MD Spine Surgeon Group Health Cooperative
Mary Kay O’Neill, MD, MBA (Chair) Executive Medical Director Regence Blue Shield
John Robinson, MD, SM Chief Medical Officer First Choice Health
Michael Von Korff, ScD Psychologist & Researcher Group Health Research Institute
Kelly Weaver, MD Physiatrist The Everett Clinic

Long-Term Opioid Therapy

Read our Report and Recommendations

(Adopted May 2020)

Supporting Materials

Letter from the Health Care Authority Accepting the Postoperative Prescribing Guidelines
Letter from the HCA Accepting Dental Prescribing Guidelines
Letter from Health Care Authority Accepting Opioid Prescribing Metrics
Opioid Guideline Implementation Charter
Agency Medical Directors Group Interagency Guideline on Prescribing Opioids for Pain
AMDG Guideline Summary

Workgroup Members

Name Title Organization
Gary Franklin, MD, MPH (Co-Chair) Medical Director Washington State Department of Labor and Industries
Charissa Fotinos, MD (Co-Chair) Deputy Chief Medical Officer Washington State Health Care Authority
Andrew Saxon, MD (Co-Chair) Director, Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Health Care System
Rose Bigham and Cyndi Hoenhous (Co-Chairs) Patient Advocates Washington Patients in Intractable Pain
Pamela Stitzlein Davies, MS, ARNP, FAANP Nurse Practitioner Departments of Neurology & Nursing, University of Washington
Andrew Friedman, MD Physical Medicine and Rehabilitation Virginia Mason Medical Center
Kelly Golob, DC Chiropractor Tumwater Chiropractic Center
Dan Kent, MD Chief Medical Officer UnitedHealthcare
Kathy Lofy, MD Chief Science Officer Washington State Department of Health
Jaymie Mai, PharmD Pharmacy Manager Washington State Department of Labor and Industries
Mark Murphy, MD Addiction Medicine and Pain Management MultiCare Health System
Anne Blake-Nickels Patient Advocate
Gregory Rudolph, MD Addiction Medicine Swedish Pain Services
Jennifer Davies-Sandler Patient Advocate
Mark Stephens President Change Management Consulting
Mark Sullivan, MD, PhD Psychiatrist University of Washington
David Tauben, MD Chief of Pain Medicine University of Washington Medical Center
Gregory Terman MD, PhD Professor Department of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology and Behavior, University of Washington
John Vassall, MD, FACP Physician Executive for Quality and Safety Comagine Health
Michael Von Korff, ScD Senior Investigator Kaiser Permanente Washington Research Institute
Mia Wise, DO Medical Director, Collaborative Healthcare Solutions Premera Blue Cross

Opioid Prescribing Metrics

Award winners for Best Practices in Opioid Prescribing Metrics:

Read our Opioid Prescribing Metrics

(Adopted July 2017)

The Washington State Agency Medical Directors Group (AMDG) developed a comprehensive Guideline on Prescribing Opioids for Pain in June 2015. The Guidelines were subsequently adopted by the Bree Collaborative at the July 2015 meeting. This workgroup will design and carry out strategies to implement the Guidelines. This workgroup met from December 2015 to April 2020.

Supporting Materials

Opioid NDC include
Opioid NDC exclude
Letter from Health Care Authority Accepting Opioid Prescribing Metrics
Opioid Guideline Implementation Charter
Agency Medical Directors Group Interagency Guideline on Prescribing Opioids for Pain
AMDG Guideline Summary

Opioid Guideline: Metrics Workgroup Members

Name Title Organization
Chris Baumgartner Director Prescription Monitoring Program Washington State Department of Health
David Buchholz, MD Medical Director Premera Blue Cross
Gary Franklin, MD, MPH (Chair) Medical Director Washington State Department of Labor and Industries
Charissa Fontinos, MD Deputy Chief Medical Officer Washington State Health Care Authority
Deb Fulton-Kehoe, PhD, MPH Epidemiologist University ofWashington
Frances Gough, MD Chief Medical Officer Molina Healthcare
Dan Kent, MD Chief Medical Officer UnitedHealthcare
Kathy Lofy, MD Chief Science Officer Washington State Department of Health
Jaymie Mai, PharmD Pharmacy Manager Washington State Department of Labor and Industries
Mark Murphy, MD Family Medicine and Addiction Medicine MultiCare
Shirley Reitz, PharmD ‎Clinical Pharmacist Client Manager OmedaRx, Cambia
Gregory Rudolph, MD Addiction Medicine Swedish Pain Services
Mark Stephens President Change Management Consulting
David Tauben, MD Chief of Pain Medicine University of Washington Medical Center
Gregory Terman MD, PhD Professor Department of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology and Behavior, University of Washington
Michael Von Korff, ScD Senior Investigator Kaiser Permanente Washington Research Institute

Opioid Prescribing in Older Adults

Award winners for Best Practices in Opioid Prescribing in Older Adults:

Read our Report

Opioid overuse poses challenges for all populations and especially for adults over 65 years of age due to psychological changes from aging causing individuals to have less predictable responses and specific risks such as from falls. Opioid use also increases the risk of hospitalization and emergency department use for those over 65 and with a significant increase nationally in opioid misuse and inpatient care use coinciding with the opioid epidemic. This workgroup met from December 2020 to July 2022.

Read our Charter

Workgroup Members

Name Title Organization
Gary Franklin, MD, MPH (Co-chair)
Jason Fodeman, MD
Jaymie Mai, PharmD		 Medical Director
Assistant Medical Director
Pharmacy Manager		 WA Department of Labor and Industries
Darcy Jaffe, MN, ARNP, NE-BC, FACHE (Co-chair) Senior Vice President, Safety & Quality WA Hospital Association
Mark Sullivan, MD, PhD (Co-chair) Professor of Psychiatry and Behavioral Sciences University of Washington
Judy Zerzan-Thul, MD, MPH (Co-chair) Chief Medical Officer WA Health Care Authority
Carla Ainsworth, MD, MPH Provider Iora Primary Care – Central District
Rose Bigham Patient Advocate
Denise Boudreau, PhD, RPh, MS Senior Scientific Investigator Kaiser Permanente Washington Health Research Institute
Siobhan Brown, MPH, CPH, CHES
Yusuf Rashid, RPh		 Senior Analyst, Health Systems Innovation
VP of Pharmacy and Vendor Relationship Management		 Community Health Plan of Washington
Pamela Stitzlein Davies, MS, ARNP, FAANP Adult/Geriatric Nurse Practitioner University of Washington / Seattle Pacific University
Elizabeth Eckstrom, MD Division of General Internal Medicine and Geriatrics Oregon Health Sciences University
James Floyd, MD Internal Medicine University of Washington School of Medicine
Nancy Fisher, MD Ex Officio Member
Debra Gordon, RN, DNP, FAAN Department of Anesthesiology and Pain Medicine University of Washington School of Medicine
Shelly Gray, PharmD School of Pharmacy University of Washington
Blake Maresh, MPA, CMBE Deputy Director, Office of Health Professions Washington State Department of Health
Wayne McCormick, MD Division of Gerontology and Geriatric Medicine University of Washington
Kushang Patel, MD Anesthesiology and Pain Medicine University of Washington
Elizabeth Phelan, MD Department of Geriatrics University of Washington
Dawn Shuford-Pavlich Home and Community Services Division Department of Social and Health Services
Angela Sparks, MD Medical Director Clinical Knowledge Development & Support Kaiser Permanente Washington
Gina Wolf, DC Chiropractor Wolf Chiropractic Clinic

Prescribing Opioids for Postoperative Pain

Award winners for Best Practices in Opioid Prescribing for Post-operative Pain:

Read our Report and Recommendations

(Adopted July 2018)

Read our Summary

Developed in partnership with the Washington Health Alliance

The Washington State Agency Medical Directors Group (AMDG) developed a comprehensive Guideline on Prescribing Opioids for Pain in June 2015. The Guidelines were subsequently adopted by the Bree Collaborative at the July 2015 meeting. This workgroup will design and carry out strategies to implement the Guidelines. This workgroup met from December 2015 to April 2020.

Supporting Materials

Letter from the Health Care Authority Accepting the Postoperative Prescribing Guidelines
Opioid Guideline Implementation Charter
Agency Medical Directors Group Interagency Guideline on Prescribing Opioids for Pain
AMDG Guideline Summary

Workgroup Members

Name Title Organization
Chris Baumgartner Director Prescription Monitoring Program Washington State Department of Health
Gary Franklin, MD, MPH (Chair) Medical Director Washington State Department of Labor and Industries
Charissa Fontinos, MD Deputy Chief Medical Officer Washington State Health Care Authority
Deb Gordon, DNP, RN, FAAN Teaching Associate, Co-director, Pain Service, Anesthesiology & Pain Medicine Harborview Medical Center
Frances Gough, MD Chief Medical Officer Molina Healthcare
Dan Kent, MD Chief Medical Officer UnitedHealthcare
Kathy Lofy, MD Chief Science Officer Washington State Department of Health
Jaymie Mai, PharmD Pharmacy Manager Washington State Department of Labor and Industries
Shirley Reitz, PharmD ‎Clinical Pharmacist Client Manager OmedaRx, Cambia
Gregory Rudolph, MD Addiction Medicine Swedish Pain Services
Mark Stephens President Change Management Consulting
David Tauben, MD Chief of Pain Medicine University of Washington Medical Center
Gregory Terman MD, PhD Professor Department of Anesthesiology and Pain Medicine and the Graduate Program in Neurobiology and Behavior, University of Washington
Michael Von Korff, ScD Senior Investigator Kaiser Permanente Washington Research Institute
Mia Wise, DO Medical Director, Collaborative Healthcare Solutions Premera Blue Cross
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