The President’s Podium: Engaged in the battle? Yes!

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

The voices of the media are becoming more frequent and more pointed about the nation’s opioid epidemic, and the Dr. Dennis Dimitri, MMS Presidentnarrative that physicians are part of the problem continues.

The suggestion that physicians are lax in addressing the opioid epidemic or are reluctant to work toward solutions has been espoused by national and local media. A November 2 editorial in The Boston Globe takes our medical society to task, suggesting that we are reluctant to work with public officials and are even obstructing progress because we believe there needs to be more flexibility in the Governor’s proposed limit of a 72-hour supply of opioids for first-time prescriptions.

The idea that physicians are standing on the sideline or hindering progress toward solutions to the opioid epidemic is simply wrong. The fact is that MMS officers and staff have been meeting and working with Governor Baker, Health and Human Services Secretary Sudders, Attorney General Healey, and Public Health Commissioner Bharel for some months in order to address this crisis and develop strategies and responses. There has been nothing casual about the MMS response to this crisis.

Our opioid prescribing guidelines, issued in May, were in fact a response to the Governor’s request for assistance in addressing the epidemic. Our guidelines outlining use of the lowest effective dose for the shortest time presaged the Governor’s opioid bill by several months, and were subsequently adopted by the Massachusetts Board of Registration in Medicine and incorporated into its comprehensive advisory to physicians on prescribing issues and practices.

Additionally, the MMS has called for every physician to rethink their prescribing practices with the goal of reducing the number of opioids prescribed. We ‘own’ that part of the problem.

We have worked with members of the Baker administration on several initiatives and have invited them to work with us as we reach out to physician leaders for help. Physicians are firmly committed to working with government leaders, public health officials, and others in the medical community to stem the tide of opioid and prescription drug abuse.

Our other actions speak to that, as well.

Our continuing medical education courses on opioid prescribing and pain management have been taken by nearly 2,000 individuals since we began offering them free in May. Nearly 5,000 courses have been taken.

We have reached out to the medical community and beyond with our annual public health forum and our Opioid Misuse and Addiction Summit, which brought together physicians, pharmacists, law enforcement officials, and government officials to create awareness and discuss strategies to reduce opioid abuse.

We have been engaged for several years in efforts with the Department of Public Health to improve the state’s Prescription Monitoring Program and are now collaborating with the DPH and the deans of the four Massachusetts medical schools to improve education on opioids and pain management for medical students.

Our dedicated website and public service advertising campaign speak to the importance of safe storage and disposal by patients, two critical elements in curbing abuse.

Physician activity in addressing the opioid crisis by the MMS is not something new in 2015. MMS efforts in alerting patients about prescription drug abuse go back nearly five years, and my predecessors Dr. Ron Dunlap and Dr. Rick Pieters were instrumental in bringing the urgency and importance of opioid abuse to our members and the patient population.

As I wrote back in July, physicians have made the commitment to be part of the solution. We will remain so and will continue to work with government and public health officials, our colleagues in the medical community, and our patients to attack this crisis.

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

  1. Johanna Klein says:

    I want to speak for the persons who are now the innocent bystanders of what may be a continuation of a drug war policy and already struggle with enormous stigma and battle chronic pain simply to be able to hold down jobs, remain in school and be contributing members to society. As physicians, citizens and parents in Massachusetts we are all concerned about what has been termed the “epidemic” of heroin and prescription drug use in our state. As noted by the response from MMS, physicians make great efforts to ensure that prescriptions written are for appropriate indications and that ongoing follow up in our offices occurs with persons on narcotics to ensure safe use and perhaps most importantly to ensure that these medications show benefit and improve quality of life. We screen urine both at regular intervals and at random. We talk with our patients, examine our patients, speak with them and their families to ensure safe use and regularly check in on side effects that may occur and how to best manage them. Every patient signs a drug contract in the office which is reviewed and signed by the physician as well.
    My patients speak often of how they are treated with suspicion and disrespect when they go the their pharmacy to pick up narcotic prescriptions. This occurs to persons who have followed all rules/instructions outlined in the contracts they’ve signed. I and many of my colleagues are very concerned with the legislation pending in front of the state house and senate. Though at present it does not address persons with chronic pain, it does erode the relationship between doctor and patient and in my opinion infringe upon it as well. Rather than try to limit amounts of pain medication for acute pain situations (do we really feel it is appropriate for legislature to dictate what a post operative patient should have) or continue to stigmatize and make the lives persons struggling with severe, chronic pain to be more difficult, I advocate more resources be put towards public health campaigns and heroin treatment centers. I certainly hope that the Massachusetts Medical Society is vocal in its advocacy for the patients who are somehow being ignored in what has become a loud public relations battle that seems determined to undermine the relationship between patient and doctor. I would appreciate any follow up comments from the organization management or members. Thank you for your time.

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