The President’s Podium: Being Part of the Solution

by Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

 In October 2Dr. Dimitri1_edited013, the Trust for America’s Health rated Massachusetts as one of the top six states for developing  strategies to curb prescription drug abuse. Despite that ranking, the Commonwealth recorded more than 1,000 deaths from opioid overdoses in 2014, a jump of 33 percent from 2012.

Today, our state has developed an even firmer resolve in response to this epidemic.

Governor Charlie Baker and Attorney General Maura Healey have made this public health crisis a top priority. The Governor’s Opioid Working Group released an action plan in June that I believe is a smart, comprehensive approach to a complex problem. From the physician’s perspective, the plan has much to like. It reframes addiction as a medical disease, and recognizes the physician’s critical concern: “to ensure access to pain medication for individuals with chronic pain while reducing opportunities for individuals to access and use opioids for nonmedical purposes.”

The plan also supports initiatives that physicians have urged for some time and embrace wholeheartedly: more drug take-back days (an effort the Drug Enforcement Administration is also reviving), increases in the co-prescribing and bulk purchasing of the life-saving drug naloxone, more treatment programs, eliminating insurance barriers to treatment, and improvements in the state’s Prescription Monitoring Program.

The monitoring program is especially significant. The Centers for Disease Control describes such programs as one of “the most promising state-level interventions” to improve prescribing and protect patients at risk.

Changes in the monitoring program will make it easier for physicians to use, and compatible with those in other states. One key improvement: reducing the time for pharmacy reporting of opioid prescriptions from two weeks to 24 hours. This will provide better “real time” information on patient prescriptions and less “doctor shopping” by patients.

Another good sign: government is allotting more resources to fight the epidemic. The new state budget includes $111 million for substance abuse services, and the Governor has requested another $27.8 million in supplemental spending for treatment and prevention. U.S. Health and Human Services has also announced a $100 million effort for medication-assisted treatment, and Massachusetts will share in that program.

Creative new approaches have come from law enforcement as well. Gloucester’s Angels Program has enrolled nearly five dozen people into treatment since it began June 1, and the program has led to similar efforts in other communities.

For our part, the Massachusetts Medical Society has reached out to all prescribers with our Opioid Therapy and Physician Communication Guidelines, offering evidence of best practices for prescribing.

In May, we made our continuing medical education courses on opioids and pain management free to all prescribers, and since then, nearly 2,500 health professionals have taken one or more courses in the first two months. To meet demand, we have added nine courses since last year, when only 400 completed such courses in a comparable period.

We are reaching out to patients, focusing on the critical areas of proper storage and disposal of medications with a dedicated website and an upcoming radio public service campaign that will continue through the end of the year.

The American Medical Association is also taking action, concentrating on physician education in prescribing opioids, use of monitoring programs, and promoting access to treatment and naloxone.

But physicians – and all prescribers – can do better. More than half of enrolled prescribers don’t routinely use the prescription monitoring program, and most patients say their doctors don’t discuss the risks of addiction when prescribing pain medication. One of the best things prescribers can do is raise patient’s awareness of the risks of addiction and their responsibility to properly store and dispose of their medications.

Let’s also remember the public has a critical role to play. More than 75 percent of those 12 and older who use pain relievers for nonmedical reasons are using drugs prescribed to someone else, whether obtained free, purchased, or stolen. As White House Drug Policy Director Michael Botticelli told our membership, the prescription opioid problem is, in one sense, “an epidemic that starts in the medicine cabinet.”

The Opioid Working Group declared that “strong partnerships” will be required to curb this abuse. Many groups are rising to meet the challenge, and physicians have made the commitment to be part of the solution as well. As those closest to the patients, as the ones who prescribe their medicines and treat their pain, we can do no less.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Dimitri’s commentary on a range of issues in health and medicine.

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