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MMA Seeks Comments on CDC Proposed Opioid Prescribing Guidelines

The Centers for Disease Control and Prevention (CDC) has released proposed guidelines for prescribing opioids for chronic pain. The Montana Medical Association is gathering comments on the guidelines from physician members to potentially submit feedback before the public comment period ends on Jan. 13 2016. The MMA is requesting members submit their comments to Jean Branscum at jean@mmaoffice.org by Monday, January 11th.

CDC Proposed Opioid Prescribing Guidelines

AMA Letter to CDC on Opioid Guidelines

In an email that went out the CDC offered this comment, “CDC is developing an opioid prescribing guideline to help primary care providers offer safer, more effective care for patients with chronic pain and help reduce misuse, abuse, and overdose from these drugs. The guideline will provide recommendations to primary care providers about the appropriate prescribing of opioid pain medications to improve pain management and patient safety. Recommendations focus on the use of opioids in treating chronic pain (i.e., pain lasting longer than three months or past the time of normal tissue healing). The guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.”

Public comments for docket #CDC-2015-0112 can be voiced here.

MT Physicians Stand Tall in Know Your Dose Campaign

CMC Breast Cancer Cernter

Prescription drug abuse and diversion is an epidemic – it affects everyone, and the statistics are staggering. Not enough Montanans are aware of the number of lives lost, making prescription painkillers 15 times more deadly than heroine, meth and cocaine combined.

Marc Mentel, D.O. was recently interviewed on Voices of Montana regarding this campaign click play below to listen in.  The Montana Medical Association thanks the Northern News Network for their help in promoting the KnowYourDoseMT.org initiative.

 

 

As physicians, we are committed to providing compassionate care to our patients following best medical practices.  There is not a pill for every ill.   When it comes to the management of chronic pain this is a truth, a tough pill to swallow.  The MMA is committed to being a positive resource that will encourage more physicians to take on the challenge of treating patients with chronic pain, so that access to care following current “best practices” will be improved, not restricted. With the tools and education on pain management and safe opioid prescribing found on knowyourdosemt.org, physicians and health care providers can be confident in their treatment of patients suffering from pain. We can ethically and reasonably care for patients and help get them to a better place in their life by following safer prescribing practices, monitoring and documenting. As medical best practices evolve bringing new knowledge to light that improves our ability to care for our patients, this website will evolve.

According to the MT Department of Public Health and Human Services, prescription drug overdoses were responsible for at least 369 deaths and more than 7200 hospital inpatient admissions and emergency department encounters in 2013 in our state. The consequences impact our families and friends, the communities we live in, and our workplaces. It also fills our physician offices and emergency departments.  The MMA and our partners are committed to providing resources and education to help fight this epidemic while providing needed medical care through our Know Your Dose initiative.

We are committed to playing a pivotal role and applaud our partners — pharmacists, nurses, dentists, public health, and law enforcement officers who are equally committed to tackling the public health crisis of prescription drug abuse.  We offer our gratitude to the Montana Medical Association Foundation, Blue Cross Blue Shield of Montana and Montana Department of Justice for providing resources, and to the Northern News Network for increasing awareness about this initiative.

It’s timely for others to step forward in support and for the general public to become more engaged.  You can be a partner in reducing supply and stopping diversion by not sharing your medications, securing and disposing unused prescription drugs and watching for signs of diversion.  We encourage you to join the fight in ending opioid abuse.  Start the conversation in your community.  Visit www.knowyourdosemt.org to make a donation and learn about this initiative.

Missoula – Marc Mentel, D.O., Montana Medical Association Prescription Drug Abuse Reduction Chair

A Glimpse into Rx Drug Abuse Know Your Dose Education

Rx drug abuse and diversion is a growing epidemic in Montana, contributing to the deaths of more than 300 Montanans each year. The Montana Medical Association and its partners designed this four module course to help health care teams find the proper balance between providing appropriate treatment for patients while protecting them from opioid addiction.

This short video provides you with just a glimpse into the four module online Prescription Drug Abuse Reduction training.

This series provides valuable information for physicians and non-physicians who are involved in patient care concerning opioid medications. Physicians are encouraged to include all appropriate members of their teams in this training. The program addresses the problem on a state and national level, how to prescribe opioids and how to communicate with patients about the dangers of prescription drugs. Non-physicians who complete the webinar and a post-webinar evaluation will also receive a certificate of completion.

MMA Education Platform

MMA Vice President, William Gallea, M.D. – Speaks on Difficulty Treating Chronic Pain

The end of July marked the launch of www.knowyourdosemt.org. The resources now available are a result of the work put forth by many physicians and other health care providers serving on MMA’s Prescription Drug Abuse Reduction Committee. It includes an educational module and a health care provider toolkit containing downloadable forms available at no cost.

The launch started in Billings and ended the following day after its promotion in four towns across Montana. Doctor Bill Gallea, MMA Vice President made a call to have physicians, health care providers and the public help attack this public health crisis in Helena, Montana.

Contact the MMA Executive Office to learn how you can promote The Know Your Dose initiative in your community at mmaoffice@mmaoffice.org.

Course Intended For All Specialties: Physicians, Dentists, Physician’s Assistants, Pharmacists, Nurses, Nurse Practitioners, Advanced Practice Nurses
Course Objectives:

  • Implement recommended prescribing practices and alternate forms of treatment for patients presenting with acute or chronic pain.
  • Use the toolkit and resources to manage patient treatment.
  • Apply the state and federal laws as related to prescribing Schedule II drugs.
  • Examine the prescription drug issue from a state and national level.

Access the Know Your Dose Medical Education Course.

Dr. Mentel, D.O. on Wake Up Montana in Missoula

On July 30th the Montana Medical Association (MMA), alongside the Department of Justice, Attorney General Tim Fox and local physician champion, Marc Mentel, D.O. announced the release of a Prescription Drug Abuse Reduction online resource center, “Know Your Dose”.

The announcement was made during a press conference held at the Family Medicine Residency of Western Montana.  The discussion offered a local physician’s perspective on the prescription drug epidemic in Missoula, an overview of the problem statewide and an introduction to newly accessible resources. The MMA provided a look at the new “Know Your Dose” website, which is designed to build awareness of the public health crisis facing Montana and to offer a one stop resource for health care providers, patients dealing with chronic non-cancer pain and the general public.

Prior to the conference, Marc Mentel, D.O. spent a few minutes with Wake Up Montana in Missoula.

MMA Backs Legislation To Help Address Prescription Drug Abuse

The Montana Medical Association is supporting three bills that would help address prescription drug abuse and diversion in Montana. The MMA worked with the Children, Families, Health & Human Services Interim Committee to come up with the three bills. The three pieces of legislation – Senate Bill 7, Senate Bill 8 and Senate Bill 9 – all are being sponsored by Senator Roger Webb of Billings.

Below are overviews of each bill and where they currently stand in the legislative process.

Senate Bill 7 (Revise and extend the prescription drug registry fee) SB 7 by Senator Roger Webb of Billings would extend the sunset for the Prescription Drug Registry and raise the fee from $15 to $30. William Gallea, M.D., noted in testimony the MMA would like to see the increased fee help pay for future enhancements, which include delegating access to support staff, the ability to share information with other states, having data available in real time and having the ability to provide feedback to prescribers. Status: Passed Senate and heard in House Human Services Committee on Jan. 23, 2015. MMA POSITION – SUPPORT

Senate Bill 8 (Allow electronic prescribing of controlled substances prescriptions) SB 8 by Senator Webb would allow for the electronic prescribing of controlled substances. Montana is the last state to adopt such a law. It will assist in making additional gains in curbing prescription drug abuse and diversion, and reducing deaths due to prescription drug abuse. Status: Passed Senate and heard in House Human Services Committee on Jan. 26, 2015.  MMA POSITION – SUPPORT

Senate Bill 9 (Allow sharing of certain health care information with law enforcement) SB 9 by Senator Webb clarifies and allows for health care providers to be able to share certain information with law enforcement, and provides immunity to providers. This bill is viewed as a tool to address doctor shopping and in making additional gains in curbing prescription drug abuse and diversion, and reducing deaths due to prescription drug abuse. Status: Failed third reading on Senate Floor on Feb. 23, 2015. MMA POSITION – SUPPORT

 

SJR 20: Prescription Drug Abuse

Montana Legislative Services – September, 2014

The 2013 Legislature approved Senate Joint Resolution 20 for a study of ways to reduce prescription drug abuse. Legislators ranked the study seventh out of 17 study resolutions in a post-session poll, and the Legislative Council assigned the study to the Children and Families Committee. The committee reviewed and adopted a study plan at its meeting on June 25, 2014.

During its study, the committee heard from medical professionals about pain management and the use of prescription narcotics; from law enforcement officials who investigate and prosecute cases involving prescription drugs; and from national experts who have studied prescription drug abuse and ways to prevent it, including the use of prescription drug monitoring programs as a preventive tool. Members also heard from Montana state agencies about steps they are taking to reduce prescription drug use, misuse, and abuse.

The committee considered five study-related bill drafts during the interim and approved three of them for introduction in the 2015 Legislature. The bills would:

  • extend the sunset date for the fee that certain health care providers pay for the Montana Prescription Drug Registry, from 2015 to 2017, and allow the fee to be increased from the current $15 to a maximum of $30;
  • allow health care providers to submit prescriptions for controlled substances to pharmacies using electronic means; and
  • clarify that health care professionals may notify law enforcement when they believe patients are illegally obtaining prescription painkillers or may cause an imminent threat to public health or safety. The bill also would provide immunity to providers who share the information.

The committee also considered draft legislation to require health care licensing boards to adopt uniform pain management rules for the use of opioids in treating chronic, non-cancer pain and to require an adult to pick up a controlled substances prescription for a minor. Based on public comment received on those drafts, the committee decided against introducing the legislation in the 2015 session.

To see all of the draft legislation and reports, please click here.

Overview of the Issue

In early 2013, the MMA began discussions on the public health crisis of opioid abuse, misuse and diversion with a focus on what the Association might do to assist physicians to become more knowledgeable of the changing best medical practices when treating patients with chronic pain, and encourage cooperation with local law enforcement officials on concerns of possible diversion.

Later that year, the MMA determined the topic demanded the creation of a work group that would bring together physicians with expertise in this area, physicians engaged in practice changes to address the issue and other stakeholders. The MMA Committee on Prescription Drug Abuse was officially launched in January 2014 with nearly 20 physician members and has since met on a regular basis to share for hours their expertise, which laid the groundwork for a framework as described below.

Statistics caught the attention of physicians and those physicians working to address this issue specifically set an overarching goal to decrease the number of overdose deaths in Montana. Statistics from the Centers for Disease Control & Prevention (CDC) note that enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for one month. Approximately, three out of every four pharmaceutical overdose deaths in 2010 were due to opioid analgesics like oxycodone, hydrocodone and methadone. Medicaid patients are prescribed painkillers at twice the rate of non-Medicaid patients and are at six times the risk of prescription painkiller overdose. And unintentional overdose deaths related to prescription opioids have quadrupled since 1999—and now outnumber those from heroin and cocaine combined. It has been further noted that within the world of workers’ compensation, there is significant proof that long-term opioid use leads to longer claim duration, longer-term disability, higher costs and higher medical expenses.

Clearly, this issue is deserving of a statewide, multi-stakeholder approach as it reaches beyond the physician office doorway. The consequences impact our families and friends, the communities we live in and our workplaces. The issue needs to be tackled from both a supply-side and demand-side, and strategies must grow from a framework directed at health care providers, patients, law enforcement and the general public. The MMA has expanded its work group to include other stakeholders and offers the below framework to describe how best to engage physicians and to offer action steps to start addressing the issue.

The MMA will move forward to ensure physicians are aware of educational training opportunities and strongly promote all physicians make the effort to be knowledgeable of current best medical practices in treating pain, create tools to assist physicians care for their patients and make available resources. We believe the call to action is now and have developed the attached timeline to keep us focused.

The MMA advocates for the state of Montana to support efforts to address the prescription drug abuse issue by being an active partner to pass legislation and provide funding, including establishing convenient, permanent drop-off bins for prescription drugs; providing funding to educate providers, patients and providers; offering legislation that clarifies current law related to the sharing of information by physicians with law enforcement and providing immunity; identifying stable funding sources for the Prescription Drug Registry; allowing electronic prescribing for controlled substances; and supporting proposals that can reduce the demand by offering treatment options for those suffering from prescription drug abuse.

MMA White Paper: A Prescription for Change: Reducing Prescription Drug Abuse, Misuse and Diversion in Montana

In early 2013, the MMA began discussions on the public health crisis of opioid abuse, misuse and diversion with a focus on what the Association might do to assist physicians to become more knowledgeable of the changing best medical practices when treating patients with chronic pain, and encourage cooperation with local law enforcement officials on concerns of possible diversion.

Later that year, the MMA determined the topic demanded the creation of a work group that would bring together physicians with expertise in this area, physicians engaged in practice changes to address the issue and other stakeholders. The MMA Committee on Prescription Drug Abuse was officially launched in January 2014 with nearly 20 physician members and has since met on a regular basis to share their expertise, which laid the groundwork for a framework as described below.

Statistics caught the attention of physicians and those physicians working to address this issue specifically set an overarching goal to decrease the number of overdose deaths in Montana. Statistics from the Centers for Disease Control & Prevention (CDC) note that enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for one month. Approximately, three out of every four pharmaceutical overdose deaths in 2010 were due to opioid analgesics like oxycodone, hydrocodone and methadone. Medicaid patients are prescribed painkillers at twice the rate of non-Medicaid patients and are at six times the risk of prescription painkiller overdose. And unintentional overdose deaths related to prescription opioids have quadrupled since 1999—and now outnumber those from heroin and cocaine combined. It has been further noted that within the world of workers’ compensation, there is significant proof that long-term opioid use leads to longer claim duration, longer-term disability, higher costs and higher medical expenses.

Clearly, this issue is deserving of a statewide, multi-stakeholder approach as it reaches beyond the physician office doorway. The consequences impact our families and friends, the communities we live in, and our workplaces. The issue needs to be tackled from both a supply-side and demand-side, and strategies must grow from a framework that is directed at health care providers, patients, law enforcement and the general public. The MMA has expanded its work group to include other stakeholders and offers the below framework to describe how best to engage physicians and to offer action steps to start addressing the issue.

To read the entire MMA White Paper on the subject, please click here.

Opiates: The Silent Epidemic

(Submitted in January, 2014)

Currently there is an epidemic sweeping this country at an unprecedented rate. The epidemic is prescription opiates. Approximately 50 people die every day from prescription opiates. Put  another way, if compared to all wars fought by the United States, the death toll from prescription opiates would be the third deadliest campaign in US history. The only wars with more casualties would be the Civil War and World War II. If this trend continues, in about 10 years the number of casualties will exceed World II at more than a half million dead.

So how did we get here? Starting around the late 90’s and into the 21st century, pain as the 5th vital sign was starting to be monitored by health care professionals. Patients who were in chronic pain were asked to rate their pain on a scale of 1-10. Pain greater than a four on this scale was deemed undesirable and would require treatment. Patients were then started on medications to alleviate pain, and opiates were the first and most common choice by many providers. Since then, physicians, dentists, nurse practitioners and physician assistants now prescribe 4-5 times the amount of opiates they did 10 years ago. Currently, there are enough opiates prescribed that every US citizen over the age of 18 could take 5mg of Lortab every four hours for the next month. We could all go on national holiday.

Over the past decade of my practice, I have witnessed the effects of monitoring pain as the 5th vital sign. I have seen children who are now being raised by their grandparents because both mom and dad overdosed on prescription Methadone. Newborns being admitted to Neonatal Intensive Care Units to withdraw from opiates for the next 4-6 weeks because mom was dependent on Lortab. Grandparents who will never see their grandchildren open Christmas presents because they themselves were on too high a dose of Fentanyl patches to wake up. Teenagers who will never graduate from high school, because they took some of mom’s perks and died in a head on collision.

For a little over a year-and-a-half, I have been actively working with our organization’s Malpractice Insurance Carrier, promoting a plan called Community Safe Prescriber. I have had the privilege to speak to some of the other organizations who share the same Malpractice Carrier in the Rocky Mountain Region. I usually begin my presentation by asking three simple questions of the providers present. Number one, how many of you have cured patients of their chronic pain with the use of prescription opiates? Number two, how many of you enjoy treating chronic pain with opiates? Number three, how many of you know somebody or someone that has died from an opiate overdose? The answers are always the same, whether I am in Nebraska, Wyoming or somewhere in Montana. Not surprisingly, I have yet to have anyone raise their hand to the first two questions. Sadly, I have yet to have anyone keep their hand down to the last question.

As a physician, I find this troublesome. I took an oath to do no harm.  If I took an oath to do no harm, why should anyone die from prescription opiates? Is the collateral damage of treating chronic non-cancer pain worth the price? Especially when there is mounting evidence that patients on chronic opiates usually have a poorer quality of life and life expectancy, when compared to those treated by other means. I don’t believe that prescribing opiates was the original intention of monitoring pain as the 5th vital sign. I believe the original intention was to monitor and search out the cause of the pain and treat accordingly. Contrary to popular belief, opiates are not a cure for chronic non-cancer pain. In fact, opiates may make pain worse in some cases. To date, there is no cure for chronic non-cancer pain.

Where do we go from here? Chronic non-cancer pain is very real and patients will do whatever they can to rid themselves of this ever present demon. However, adding the lifelong sentence of opiates may be another demon they were not expecting. In my opinion, to treat patients appropriately, and to stem the current epidemic, it will take a change of current prescribing patterns and patient and provider responsibilities. Providers need to monitor patients on a routine basis with follow up visits and periodic urine monitoring to ensure patients are kept safe. Patients will need to keep their medications secure so that it can’t get into the wrong hands. The health care community at large will need to be involved in educating their citizens about the dangers of opiates. However, before any of the above can occur, we must first acknowledge this silent epidemic exists and give it a voice.

— Mark Mentel, D.O., Community Medical Center, Missoula

Prescription Drug Abuse

The Centers for Disease Control and Prevention (CPC) has classified prescription drug abuse as an epidemic. While there has been a marked decrease in the use of some illegal drugs like cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people aged 12 and over who used drugs for the first time in 2009 began by using a prescription drug non-medically.

Some individuals who misuse prescription drugs, particularly teens, believe these substances are safer than illicit drugs because they are prescribed by a healthcare professional and dispensed by a pharmacist. Addressing the prescription drug abuse epidemic is not only a top priority for public health, it will also help build stronger communities and allow those with substance abuse disorders to lead healthier, more productive lives.

For more information, including useful resources, please click here.

 

PRESCRIPTION ABUSE PREVENTION
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