MMAadmin, Author at Know Your Dose

New AMA report details grim realities of worsening overdose epidemic

CHICAGO — The 2023 Overdose Epidemic Report (PDF), released today by the American Medical Association (AMA), finds opioid prescribing by physicians and other health professionals decreased for the 13th consecutive year, down nearly 50% since 2012, while overdoses and deaths related to illicitly manufactured fentanyl, xylazine and other synthetic substances continue to increase. In 2022, more than 107,000 people died from a drug-related overdose in the United States. Data shows the epidemic is increasingly impacting young people, Black and Brown people, and pregnant people.

There have been signs of progress in the past year—notably community-based distribution of naloxone by leading harm reduction supporters and approval by the U.S. Food and Drug Administration of over-the-counter (OTC) naloxone, which the AMA has long championed. Naloxone dispensing has increased more than 200% since 2018. The AMA continues to support widespread distribution of naloxone and urges physicians to educate patients on naloxone and prescribe to patients at risk of overdose.

“Naloxone is one success story we’ve seen this year because access to opioid-overdose reversal medications continues to save tens of thousands of lives,” said Bobby Mukkamala, M.D., chair of the AMA Substance Use and Pain Care Task Force. “Unfortunately, we are at a place where naloxone needs to be available as easily as a first aid kit or a defibrillator in public spaces. While we continue to study and address the underlying factors that contribute to substance use disorders, policymakers must look at additional, evidence-based harm reduction strategies to combat the skyrocketing number of overdoses.”

“The AMA remains focused on advocating for meaningful policy implementation and enforcement to support affordable, accessible, evidence-based care for patients with a substance use disorder as well as for patients with pain,” said Dr. Mukkamala. “Health insurers must stop dragging their feet when it comes to eliminating barriers to accessing these treatments and do their part to end the epidemic. Without action on the policy recommendations in this report, the epidemic will continue to harm and kill Americans.”

The report calls for immediate action on strategies including:

An increase in harm reduction resources such as naloxone, syringe services programs and fentanyl test strips. Naloxone should be stocked in schools, universities, and other public venues. The AMA urges all manufacturers of overdose reversal agents to submit OTC applications and price their products responsibly. Payers must also cover naloxone at low- or no-cost.
Policymakers should support legislative and regulatory actions to remove administrative and other barriers such as prior authorization, step therapy and dosage caps for medications to treat opioid use disorder (MOUD), including dosage caps on buprenorphine. The special rules that had prevented most physicians from prescribing buprenorphine were finally eliminated this year, but removal of the remaining barriers to care that needlessly prolong this devastating epidemic is long overdue.
State insurance departments must enforce mental health and substance use disorder (SUD) parity laws. The Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted in 2008 to protect individuals with a mental illness or SUDs. Because health insurers systematically fail to comply with the law on their own, state and federal regulators must (1) increase meaningful enforcement of the law; (2) significantly increase financial and other penalties against health insurers who violate the law; and (3) require comprehensive corrective actions from health insurers to meaningfully protect patients.
State officials should remove punitive policies against pregnant individuals and parents who have a SUD. State departments of corrections and private jails and prisons need to ensure that all individuals with an opioid use disorder or mental illness receive evidence-based care while incarcerated—and are linked to care upon release. This includes ensuring access to MOUD.

Additional recommendations and data are in the full report (PDF).

State-by-state trend data for opioid prescriptions, MOUD, naloxone and state prescription drug monitoring programs can be found on the AMA overdose epidemic website.

New AMA report details grim realities of worsening overdose epidemicMMAadmin2023-11-09T20:31:12+00:00

Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use

“The committee recommends that states, with assistance from relevant federal agencies, particularly the Substance Abuse and Mental Health Services Administration, provide universal access to evidence-based treatment for opioid use disorder (OUD), including use of medication, in a variety of settings, including hospitals, criminal justice settings, and substance use treatment programs. Efforts to this end should be carried out with particular intensity in communities with a high burden of OUD. State licensing bodies should require training in treatment for OUD for all licensed substance use disorder treatment facilities and providers (Recommendation 5-6). The committee recommends that schools for health professional education, professional societies, and state licensing boards require and provide basic training in the treatment of opioid use disorder for health care providers, including but not limited to physicians, nurses, pharmacists, dentists, physician assistants, psychologists, and social workers (Recommendation 5-7). The committee recommends that the U.S. Department of Health and Human Services and state health financing agencies remove impediments to full coverage of medications approved by the U.S. Food and Drug Administration for treatment of opioid use disorder (Recommendation 5-8). ”

In the context of the growing opioid problem, the FDA launched an Opioids Action Plan in early 2016. One component of the FDA plan is to reassess the agency’s risk-benefit framework for opioid approval and monitoring. The FDA commissioned this study specifically to inform this reassessment. Read Full Study Here

Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid UseMMAadmin2017-07-26T21:58:30+00:00

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 [email protected] 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.

MMA Seeks Comments on CDC Proposed Opioid Prescribing GuidelinesMMAadmin2016-01-07T18:02:46+00:00

MT Physicians Stand Tall in Know Your Dose Campaign

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

MT Physicians Stand Tall in Know Your Dose CampaignMMAadmin2016-10-31T17:54:28+00:00

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

A Glimpse into Rx Drug Abuse Know Your Dose EducationMMAadmin2016-10-31T17:54:28+00:00

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 [email protected].

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.

MMA Vice President, William Gallea, M.D. – Speaks on Difficulty Treating Chronic PainMMAadmin2016-02-24T20:33:31+00:00

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

On July 30^th 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.

Dr. Mentel, D.O. on Wake Up Montana in MissoulaMMAadmin2016-02-24T20:33:13+00:00

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

MMA Backs Legislation To Help Address Prescription Drug AbuseMMAadmin2016-10-31T17:54:29+00:00

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.

SJR 20: Prescription Drug AbuseMMAadmin2016-10-31T17:54:29+00:00

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.

MMA White Paper: A Prescription for Change: Reducing Prescription Drug Abuse, Misuse and Diversion in MontanaMMAadmin2015-07-14T15:13:30+00:00

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