opioids

Senator Markey Headlines MMS Opioid Summit

Posted in Health, Health Policy, opioids, Public Health, Uncategorized on November 1st, 2016 by MMS Communications – Comments Off on Senator Markey Headlines MMS Opioid Summit

On October 31, MMS sponsored a leadership summit on opioid addiction, Medication Assisted Treatment: Improving Access to Evidence-Based Care, an event intended to raise awareness of the need for medication assisted treatment for substance use disorder. The summit was attended by nearly 200 health care professionals at MMS headquarters in Waltham.

U.S. Senator Edward J. Markey, in his keynote address, said, “If we are going to reduce the supply for heroin, fentanyl, and illicit prescription opioids, we have to reduce the demand through treatment.”

“I will not stop fighting for legislative support on this issue,” Sen. Markey added, noting that despite his efforts and those of his colleagues, Congress has repeatedly rejected bills that would financially support addiction recovery programs.

He decried the rising numbers of deaths in Massachusetts due to overdoses  — doubling in number in the Bay State in one year — and warned that due to the potent influx of fentanyl from China and Mexico, “we are poised to lose even more lives.”

Gathered for the Opioid Summit: Dr. Dennis Dimitri, Dr. Monica Bharel, Sheriff Peter Koutoujian, Senator Edward Markey, MMS President Dr. James Gessner, MMS President-Elect Dr. Henry Dorkin, MMS Vice President Dr. Alain Chaoui

Gathered for the Opioid Summit: Dr. Dennis Dimitri, Dr. Monica Bharel, Sheriff Peter Koutoujian, Senator Edward Markey, MMS President Dr. James Gessner, MMS President-Elect Dr. Henry Dorkin, MMS Vice President Dr. Alain Chaoui

“Fentanyl is like a Class 5 hurricane making landfall,” Sen. Markey said. “It is the Godzilla of opioids. It is trending too quickly. It is so dangerous that first responders insist on wearing HazMat suits when they arrive at a scene of an overdose for fear they will become contaminated if exposed to it. We just don’t know how dangerous it is, and it’s coming to every street in America.”

Combatting the opioid epidemic requires vigilance coupled with “aggressive data collection, surveillance, increased prescriber and patient education, and the passage of aggressive new laws,” he said, that are aimed at controlling the influx and consumption of opioid drugs.

Markey alerted attendees to a report by U.S. Surgeon General Dr. Vivek Murthy on opioids due to be released early in 2017.

“The Surgeon General’s report on opioids will have a great societal impact,” Sen. Markey said, “similar to when the former Surgeon General years ago released the report about the health hazards of cigarette smoking. History will judge us, because now is our opportunity to respond to the greatest public health crisis in the 21st century.”

Several speakers, including Massachusetts Public Health Commissioner Monica Bharel, M.D., Middlesex County Sheriff Peter J. Koutoujian, and others called for a unified effort to destigmatize those who struggle with substance abuse.

“Treatment works, recovery is possible,” Koutoujian said. He described treatment programs sponsored by the Bay State’s criminal justice system that are helping inmates to return to society after incarceration better able to control their drug habits.

Dr. Bharel reminded the capacity audience to commit to viewing substance abuse addiction through the lens of the #StateWithoutStigMA campaign, launched last year by Governor Charlie Baker’s Opioid Working Group. The statewide campaign aims to eradicate the negative stereotype of drug misuse by declaring it to be a treatable illness.

MMS gathered more than a dozen national and local experts on the topic for this summit to speak to such topics as the treatment of addiction as a disease, the importance of psychological treatment and behavioral support, models of care, and supporting physicians and providers in treating opioid use disorders. It was hosted by MMS President James S. Gessner, M.D. and moderated by Dennis M. Dimitri, M.D., immediate past president and Chair of the MMS Task Force on Opioid Therapy and Physician Communication.

Presentations by the participants may be viewed here.  For highlights and photos from the event visit the MMS Twitter page.

Update: Opioid Education Surpasses 20,000 Courses

Posted in Board of Medicine, Drug Abuse, opioids on October 7th, 2016 by MMS Communications – Comments Off on Update: Opioid Education Surpasses 20,000 Courses

RXMonitoringOne of the major efforts MMS has engaged in to address the opioid epidemic in the Commonwealth has been prescriber education.  Our Opioid Therapy and Physician Communication Guidelines, developed by the MMS Task Force on Opioid Therapy and Physician Communication and issued in May of 2015, laid the groundwork in providing guidance to physicians in prescribing opioids to patients.  Those guidelines have been adopted by the Massachusetts Board of Registration in Medicine and incorporated into its comprehensive advisory to physicians on prescribing issues and practices.

Another major contribution by MMS in addressing the epidemic has been the offer of free continuing medical education courses in opioids and pain management for all prescribers. That effort also began in May of last year. A total of 18 courses and modules are available.

A previous blog post in August has discussed how this activity is having a positive impact, helping to reduce opioid prescribing rates across the Commonwealth.  Three separate studies, released in June, July, and August, have catalogued a decline in prescribing rates.

MMS today can report that since the offer of free courses began on May 26, 2015, the number of courses taken has surpassed 20,000.  As of October 7, a total of 20,249 courses have been taken by 7,084 individuals.

MMS Prescriber Education: 17,063 courses, 5,905 individuals

Posted in Department of Public Health, Drug Abuse, opioids on August 5th, 2016 by MMS Communications – 1 Comment

MMS has engaged in many efforts to address the opioid epidemic in the Commonwealth, from creating prescribing guidelines to public information campaigns for patients.  One of the major contributions of the Society – and one of the critical steps in alleviating the crisis as MMS President James S. Gessner, M.D. has noted — has been prescriber education.

MMS began offering free continuing medical education courses in opioids and pain management to all RXMonitoringprescribers beginning in May of last year, and demand for the courses has been high.

Over the 14-month period from May 26, 2015, when the free courses were first offered, through August 1, 2016, a total of 17,063 courses have been completed by 5,905 individuals. Currently, 18 courses are offered.

The courses appear to be having a positive impact, as multiple studies show that opioid prescribing has declined significantly in the state.

A study by athenahealth showed that the number of patients in Massachusetts who were prescribed opioids between the first and second quarter of 2016 dropped 14 percent, compared to an 8 percent decline for the rest of the nation.  Another study, released in June by the Cambridge-based Workers Compensation Research Institute, recorded decreases in the amount of opioids prescribed per worker’s compensations claims in the Commonwealth as well as many other states.

Finally, a Massachusetts Department of Public Health report, issued on August 3, noted that data from the state’s Prescription Drug Monitoring program showed that the total number of opioid Schedule II prescriptions and the number of individuals receiving Schedule II prescriptions were both at their lowest levels since the first quarter of 2015.  DPH said that the number of individuals who received one or more prescriptions for opioids dropped 16 percent from the first quarter of 2015 to the second quarter of 2016.

Despite the decline in prescription medications, deaths from opioid overdoses continue to rise, fueled by the synthetic opioid, fentanyl.  DPH reported that 66 percent of confirmed opioid-related overdoses deaths so far in 2016 involved fentanyl, an increase over  2015, when the rate was 57 percent.

The President’s Podium: A Step Forward in the Opioid Battle

Posted in Department of Public Health, Drug Abuse, opioids, Public Health on July 22nd, 2016 by MMS Communications – 1 Comment

by James S. Gessner, M.D., President, Massachusetts Medical Society

Congress has helped Massachusetts and the nation take another step forward in the battle against prescription drug abuse. The Comprehensive Addiction and Recovery Act (CARA), a bipartisan effort incorporating several pieces of legislation targeted at opioid abuse, has been passed overwhelmingly by the House and Senate, and President Obama has signed it into law.

A compelling need to fund some of the law’s provisions still remains, but the symbolism and substance of its passage, like the enactment of Governor
Dr. James S. Gessner, MMS President '16-'17_editedCharlie Baker’s opioid bill in March, is hard to overstate.  According to the Centers for Disease Control, drug overdose deaths in the U.S. hit record numbers in 2014.  While heroin and fentanyl certainly claim their share of lives, prescription opioids continue to fuel the epidemic: at least half of all opioid overdose deaths involve a prescription opioid, and in 2014, more than 14,000 people died from overdoses involving prescription opioids. In Massachusetts alone, more than 1,500 opioid-related deaths occurred in 2015.

CARA includes several important provisions, including greater access to the life-saving therapies of naloxone and buprenorphine, help for infants and veterans, and the reauthorization of the National All Schedules Prescription Electronic Reporting Act, or NASPER, which provides for prescription monitoring programs that have proven to reduce opioid prescribing and overdose deaths.

One provision of CARA, however, can make a big difference: partial-fill prescriptions that will help patients balance the need to relieve pain with an adequate supply of medication by only filling part of a prescription.

The importance of a partial-fill prescription is that it can help to cut drug diversion – something that makes up a significant part of the opioid abuse crisis.  Estimates from the National Institute on Drug Abuse indicate that the majority of individuals – up to an astonishing 70 percent – who misuse or abuse pain medications get them from prescriptions written for someone else, such as family or friends.

Advocated by Massachusetts physicians, the partial-fill legislation was championed by Senator Elizabeth Warren and Congresswoman Kathrine Clark, who co-sponsored the Reducing Unused Medications Act of 2016 that became part of CARA. With few exceptions, U.S. Drug Enforcement Administration regulations had previously prevented partial-fill prescriptions.

While state law also now permits partial-fills, passed as part of the Governor’s opioid bill due to the efforts of Senator John Keenan of Quincy, the Federal law goes a step further by allowing the patient to fill the unused portion of the prescription, should patients need more relief.  State law currently does not.  This new provision in CARA will enable Massachusetts to change its law to become aligned with the new Federal law, as well as give other states the ability to pass partial-fill legislation.

In prescribing pain medicines, physicians are challenged with balancing the risk of addiction versus ensuring adequate pain relief for their patients. In efforts to reduce patients’ pain, however, too many prescriptions have been written, and prescription opioids have played a major role in driving this epidemic. Partial-fill prescriptions have the potential to shrink the amount of drugs susceptible to abuse and misuse or theft from unsecured locations such as family medicine cabinets – the place where Director of the White House Office of National Drug Policy Michael Botticelli has said the epidemic starts.

The law permitting partial-fill prescriptions is another in a long list of substantive efforts taken to address the opioid epidemic.  Here in Massachusetts, we perhaps have had more actions taken much sooner than elsewhere to fight opioid abuse. Governor Baker’s Opioid Working Group that led to bipartisan landmark legislation, law enforcement programs such as Gloucester’s Angel Program and the Middlesex County Sheriff’s Office MATADOR program for inmates, prescribing guidelines and prescriber education offered by our state medical society, and public information campaigns are among endeavors contributing to prevention, education, treatment, recovery.  These efforts, underway for more than a year now, are now beginning to see some results in recovery and reduced prescribing rates.

Another major step will be taken in August, when the Department of Public Health launches its new prescription monitoring program, offering enhanced searching capability along with access to data from other states.

These actions provide encouragement and hope. Yet despite this momentum, the rate of opioid-related deaths in the Commonwealth continues to climb  – a stark reminder of the human cost of this epidemic.  And those rising numbers keep sending us an important message: that’s there’s no room for complacency, a need for even more vigilance, and a long, long way to go before we can claim real progress.

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

 


The President’s Podium: Encouraging Prescriber Education  

Posted in Drug Abuse, opioids, Public Health on June 24th, 2016 by MMS Communications – Comments Off on The President’s Podium: Encouraging Prescriber Education  

by James S.  Gessner, M.D., President, Massachusetts Medical Society

It is not an exaggeration to say that the Massachusetts Medical Society has been the leading health care organization in the Commonwealth responding to the opioid epidemic. For more than a year, we have been working with state and public health officials, legislators and other health care leaders and have developed multiple responses to address the crisis.  Gessner Crop

My predecessor, Dr. Dennis Dimitri, has been extraordinary in leading MMS over the past year and making the crisis the society’s number one priority. As Chairman of the Task Force on Opioid Therapy and Communication, I was privileged to be part of those efforts.

One of our major activities has centered on education, for both patients and physicians.  We have created a website and produced public service and video programs for patients, urging proper storage and disposal, consideration of alternative therapies, and discussions with their physicians on how best to treat pain.

One area we’re having significant impact is prescriber education.

This effort began with the issuance of our Opioid Therapy and Physician Communication Guidelines in May of 2015.  Developed with the most relevance for physicians and health professionals in primary care — those who prescribe the majority of pain medications – these guidelines were subsequently adopted by the Massachusetts Board of Registration in Medicine and incorporated into its comprehensive advisory to physicians on prescribing issues and practices.

In that same month, we started offering our continuing medical education courses on opioids and pain management free to all prescribers. We recognized early that prescriber education would be a critical step in addressing the opioid epidemic and that our society could make a significant contribution by sharing our resources.

The response to these courses has been encouraging indeed.

In a span of 13 months, from May 2015 through June 20 of this year, a total of 15, 175 of the Society’s continuing medical education courses in pain management and safe opioid prescribing have been completed by 5,265 individuals. Of those, 86 percent are physicians, and 66 percent practice in Massachusetts.

We currently offer 18 opioid and pain management online courses, with a range of content. Among the topics are managing pain without overusing opioids, managing risk when prescribing narcotics, safe prescribing for chronic pain, screening and evaluation of substance abuse disorder, and alternative therapies to opioids.  These courses are reviewed and updated regularly, to provide health professionals with the latest information on opioids and pain management.

Our prescriber education efforts, however, have gone even further, to include working with state public health officials and the deans of the state’s four medical schools in creating core competencies on opioids and pain management for medical school students and reaching out to academic medical centers in developing similar educational offerings for residency training programs.

Prescriber education remains one of the critical steps to alleviating the opioid crisis – a fact recognized by Governor Charlie Baker, who also realizes the key role physicians must play in resolving this crisis: “I think we have to be incredibly vigilant and aggressive about working with our colleagues in the health care world on this if we expect to have any long-term success at all,” he told The Boston Globe.

Physicians have a unique role in health care, and we are clearly demonstrating that with our response to the opioid epidemic. MMS will continue its efforts to educate physicians, to improve prescribing practices and reduce the amount of drugs that can be abused or misused.

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

 

 

 

The President’s Podium:  Education Is Key to Opioid Battle       

Posted in Drug Abuse, opioids, Physician Focus, Public Health on April 14th, 2016 by MMS Communications – Comments Off on The President’s Podium:  Education Is Key to Opioid Battle       

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

Multiple efforts have been taken by many people all over the Commonwealth during the last year to curtail the state’s opioid epidemic.  We’ve seen Dr.DimitriMMS (4)Governor Charlie Baker’s Opioid Working Group present 65 recommendations to attack the crisis,  law enforcement officials offer treatment instead of arrest, Department of Public Health work on improving the Prescription Monitoring Program, and the deans of the state’s four medical schools establish core competencies in opioids and pain management for medical students.

Our own medical society has been at the forefront of addressing the crisis, with prescribing guidelines, free pain management CME’s to all prescribers, public service campaigns for patients, and collaboration with state and public health officials on a variety of initiatives.

Our latest effort is yet another cooperative endeavor with the Department of Public Health. I am privileged to appear as a guest with Monica Bharel, M.D., M.P.H., Commissioner of the Massachusetts Department of Public Health, on Crisis in the Commonwealth: Opioid and Prescription Drug Abuse, the most recent edition of our monthly patient education television series, Physician Focus, produced in cooperation with HCAM-TV in Hopkinton.

Hosted by Lynda Young, M.D., Professor of Pediatrics at UMass Medical School and a past president of MMS, the show is intended to educate citizens across the Commonwealth, providing perspectives about many aspects of the opioid crisis: the origins of the epidemic, the impact on patients and families; the roles of prescriber and patient; actions taken by medical, state, and public health agencies; and the provisions of the new state law recently signed by Governor Baker to address the epidemic.

The half-hour program is being distributed to public access television stations across the state, within reach of citizens in some 275 communities, and it is also being posted online at several sites. The video also includes a public service announcement and a listing of local and national resources about substance abuse, opioids and pain medicines, and prevention and treatment options.

While the efforts of many have led to some progress over the last year, the opioid epidemic is a difficult one to attack, as evidenced by recent headlines: Middlesex County saw 20 deaths from overdoses in just three weeks, and an analysis by the Massachusetts Health Policy Commission revealed that opioid-related visits to hospitals nearly doubled from 2007 to 2014, reaching 57,000 in 2014.

The opioid crisis has been the Medical Society’s number one priority for the last year, and it will remain at the top of the list.  The video produced with the Department of Public Health is another initiative by physicians and targets what we believe to be one of the keys to success:  education for both patients and prescribers, current and future. As Dr. Bharel states early in the video discussion, “It’s so important that we talk about this and make sure we’re educated and understand the scope of the problem.”

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

 

April Physician Focus: The Opioid Crisis

Posted in Department of Public Health, Drug Abuse, opioids, Physician Focus, Public Health on April 14th, 2016 by MMS Communications – Comments Off on April Physician Focus: The Opioid Crisis

The Massachusetts Medical Society, in cooperation with the Department of Public Health, has taken another step in its efforts to address the publicOpioids_edited health crisis of opioid and prescription drug abuse affecting residents of the Commonwealth.

The April edition of Physician Focus, Crisis in the Commonwealth: Opioid and Prescription Drug Abuse, examines multiple aspects of the opioid epidemic with MMS President Dennis M. Dimitri, M.D. (photo, center) and DPH Commissioner Monica Bharel, M.D., M.P.H., (right), two physicians who have been at the forefront of addressing the problem over the last year.

Hosted by Lynda Young, M.D., (left) Professor of Pediatrics at UMass Medical School and a past president of MMS, the program represents another initiative by the physician community and seeks to educate prescribers, patients, and citizens about the crisis and what steps they can take to help to curtail the abuse.

Among the topics of conversation are the origins of the opioid crisis; the roles of prescribers and patients; actions taken by medical, state, and public health agencies to reduce the abuse; and the provisions of a new state law created specifically to fight the epidemic.  The video also contains a public service announcement recorded by the guests and a list of local and national resources about substance abuse, opioids and pain medicines, and prevention and treatment options.

Physician Focus is distributed to public access television stations throughout Massachusetts, reaching residents in more than 275 cities and towns. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org/opioids, and on YouTube.

The President’s Podium: MMS Grassroots Advocacy Leads to Another Positive Step in the Opioid Battle

Posted in Drug Abuse, Leadership, opioids, Public Health on February 26th, 2016 by MMS Communications – Comments Off on The President’s Podium: MMS Grassroots Advocacy Leads to Another Positive Step in the Opioid Battle

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

Dr. Dennis Dimitri, MMS PresidentLed by two members of the Massachusetts congressional delegation, another encouraging step has been taken in the battle against opioid abuse, and it is a prime example of the value and effectiveness of the Massachusetts Medical Society’s grassroots physician advocacy.

In a bipartisan effort, Senator Elizabeth Warren and Representative Katherine Clark, along with Senator Shelley Moore Capito (R-West Virginia) and Representative Steve Strivers (R-Ohio), have filed legislation in Congress to allow the partial filling of opioid prescriptions.

The Reducing Unused Medications Act would permit prescriptions for pain medications to be partially filled at the request of the physician or patient. The goal of the bill is simple: to reduce the amount of unused pain pills, thereby limiting the number of drugs that can be diverted.

It is a critically important goal. One of the major factors contributing to the opioid epidemic is the availability of prescription medications. Physicians have come to realize that, in their efforts to reduce pain, too many prescriptions have been written. This overprescribing has led to the diversion of medications, so much so, in fact, that the majority of individuals – estimates are about 70 percent – who misuse or abuse pain medications get them from prescriptions written for friends or family. The number of Americans 12 years of age and older who report using prescription pain medications for nonmedical use approaches 12 million.

A partial-fill prescription would help patients balance the need to relieve pain with an adequate supply of pain medication by only filling part of the prescription. Should they need additional pain relief, patients will be able to return to the pharmacy to fill the remaining portion of their prescription. Partial-fill prescriptions can be a useful tool for physicians, many of whom find it genuinely hard to know how much pain medication to prescribe.

The idea of partial-fill prescriptions began within our own medical society, with the concept first surfacing at a Worcester North District Medical Society meeting with my predecessor, Dr. Rick Pieters. With MMS advocating for its adoption, the idea caught the attention of elected officials at both the state and Federal levels.

Massachusetts State Senator John F. Keenan (D-Quincy), who served as Vice Chair of the Special Senate Committee on Opioid Addiction Prevention, Treatment and Recovery Options, included a provision for it in a bill the Senate passed last year, and Senator Warren and Representative Clark have now filed a bill in Congress.

Questions remain, however, about the legality of partial-fill prescriptions. Current Drug Enforcement Administration regulations allow for partial fills for Schedule III, IV, and V, but prohibit them, with few exceptions, for Schedule II.

The legislation filed by Senator Warren and Representative Clark (which follows an effort last year by both legislators, supported by the entire Massachusetts Congressional delegation and dozens of others members of Congress, urging DEA to allow such prescriptions) elevates the importance of this step in the fight against opioid abuse. Most importantly, the bill would provide clarity from the DEA about the legality of partial-fill prescriptions and permit states to act.

MMS strongly supports partial-fill prescriptions and believes they can be an important tool in fighting opioid abuse. Last year, at the Massachusetts State House we testified in support of House Bill 1929, legislation permitting partial-fill prescriptions, with the caveat that the bill allow for the remainder of the partial-filled prescription to remain valid.

Improving the way prescription painkillers are prescribed can reduce the number of people who misuse, abuse, or overdose from these powerful drugs, while making sure patients have access to safe, effective treatment. The partial-fill concept is one way to do that, and we are encouraged by and strongly endorse the action of Senator Warren and Representative Clark.

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

The President’s Podium: Physicians, Opioids, and Guns

Posted in gun control, opioids on January 15th, 2016 by MMS Communications – 1 Comment

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

From Medicare to electronic medical records to telemedicine, physicians are facing a variety of issues this year. Here’s a look at three that our medical society will focus on in the months ahead.

A renewed spirit by physicians about our profession
In my inaugural address upon becoming president last May, I spoke about the declining satisfaction within our profession. While Dr.DimitriMMS (4)recognizing that physician stress and frustration have increased, and that the business of medicine has added roadblocks to our practice of medicine, I urged physicians to remember how we affect the lives of our patients, that they look to us to help them overcome their problems, and that it is our privilege to do so.

As we continue to deal with the changing aspects of our profession, let’s remind ourselves that we enjoy enormous public respect and prestige, and that we make a difference, every day, to our patients and to our communities. I believe this topic to be so important, in fact, that our Educational Program at the annual meeting in May will be built upon the theme of Sustaining Joy in the Practice of Medicine.

Reducing opioid and prescription drug abuse
The MMS has taken a leadership role in the Commonwealth in combatting opioid abuse, and our efforts in this area are a prime example of how physicians can make a difference. We have developed prescribing guidelines for physicians that address pain management and addiction and have educated patients about safe storage and disposal of opioids. We have sponsored forums and summits related to opioids, and worked with public health and elected officials in improving prescription monitoring and creating strategies to reduce prescription drug abuse.

Despite those efforts, along with those of law enforcement, state officials, legislators, and many others, the numbers of overdoses and deaths continue to rise. Further, a recent study by Boston Medical Center, showing that more than 90 percent of people who survived a prescription overdose were able to get another prescription for the drug that almost killed them, demonstrates just how hard this problem is to solve. Though many of us understand the complexities that drive continued prescribing in some of these situations, studies like this can cause physicians to close what the study authors suggest are “major gaps in communication, education, and oversight” despite our deep concern about opioid abuse.

I told MMS delegates at our Interim Meeting in December that the opioid crisis is our medical society’s top issue. It remains so, and we will continue our efforts to curb opioid misuse, while at the same time ensuring that those patients who truly need help for chronic pain will be able to get it.

A new focus on physicians and gun violence
Gun violence has continued to be one of the major issues in public health. Last March, MMS took the occasion of Doctor’s Day to raise awareness about this issue, and specifically, preservation of the right of physicians to discuss the subject with their patients. Unfortunately, the 2011 Florida law making it illegal for physicians to ask patients if they own a firearm or record information about gun ownership in their medical record was upheld in December for a third time in a decision by a three-judge panel of the U.S. Court of Appeals for the Eleventh Circuit.

According to reports, the panel’s opinion was that “the law fits well within the traditional authority of the states to define and regulate the practice of medicine.” Not to be deterred, physicians will appeal for a third time to have a full court review. This remains a critical case for physicians, as it has national implications and directly affects the physician-patient relationship.

MMS physicians have addressed violence intervention and prevention in many forms, and gun violence is as appropriate for physicians to study as youth violence, partner violence, or human trafficking. To that end, our 2016 Public Health Leadership Forum, Firearm Violence: Policy, Prevention & Public Health, will seek to provide practical information for physicians on gun violence and what we can do to protect patients from harming themselves or others.

Physician satisfaction, opioids, and gun violence certainly will not be the only subjects commanding the attention of our medical society in 2016. But each of these three is a major issue growing in importance with critical implications for both physicians and patients. Each also speaks to the mission of our medical society: to “advocate for the shared interests of patients and our profession.”

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

CDC Opens Draft Opioid Guidelines for Public Comment

Posted in opioids, Palliative Care on December 23rd, 2015 by MMS – 1 Comment
CDC Director Tom Frieden

CDC Director Tom Frieden

The Centers for Disease Control and Prevention this month released its draft guidelines for the prescribing of opioid pain medications for chronic pain.

The recommendations are designed for primary care settings, and focus on chronic pain lasting longer than three months. They do not apply to palliative or end of life care. They were published on Dec. 14 and will be open for public comment until Jan. 13, 2016.

In its public notice the CDC stated, “The guideline is not a federal regulation; adherence to the guideline will be voluntary.” However, the American Medical Association and others noted that the guidelines would likely have significant public impact. For example, a new federal law requires the Veterans Administration to adopt the final CDC guidelines as official policy.

Here’s an outline of the CDC’s draft recommendations:

  1. Non-pharmacologic therapy and non-opioid pharmacologic therapy are “preferred” for chronic pain.
  2. Providers should establish treatment goals before starting opioid therapy for chronic pain.
  3. Providers should discuss the risks and “realistic benefits” of opioid therapy before starting opioid therapy, and periodically thereafter.
  4. Providers should prescribe immediate-release opioids for chronic pain, instead of extended-release opioids.
  5. Providers should start with the “lowest effective dosage.”
  6. For acute pain, providers should prescribe the “lowest effective dosage” for immediate-release opioids, and should prescribe “no greater quantity than needed for the expected duration of pain severe enough to require opioids. It states, “three or fewer days usually will be sufficient for most non-traumatic pain not related to major surgery.”
  7. Providers should evaluate the benefits and harms of with patients within 1 to 4 weeks of starting opioid therapy.
  8. Providers should evaluate risk factors for opioid-related harms before starting or continuing opioid therapy. These risk factors include the patient’s history of overdoses and/or history of substance abuse disorder.
  9. Providers should review the patient’s prescription history using the state prescription monitoring program when starting therapy, as well as periodically during therapy.
  10. Providers should use urine drug testing before starting opioid therapy for chronic pain, and should consider ordering such tests annually.

There have been strong reactions to the guidelines, focusing on both the content and the process under which the guidelines were developed.

The CDC did not originally plan to accept public comments before finalizing the guidelines, but the American Medical Association and other groups have criticized a “lack of transparency” in the drafting process.

An AMA letter to the CDC in October also stated the guidelines are “devoid of a patient-centered view and any real acknowledgement or empathy of the problems chronic pain patients may face.”

The House Committee on Oversight and Government Reform has also launched an investigation into the drafting process.

As of Dec. 30, the CDC’s website had collected more than 1,300 public comments. The AMA is expected to submit comments on the current draft in early January.

Background information