opioids

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

Open Letter to the People of Massachusetts

Posted in opioids on November 16th, 2015 by MMS – Comments Off on Open Letter to the People of Massachusetts

Globe: Open Letter to the People of MassachusettsThis letter also appeared on Page A13 of the Boston Sunday Globe on Sunday, Nov. 15, 2015.

Dear Friends:

A horrible epidemic of opioid overdoses has been sweeping our Commonwealth. Thousands of people have died, and many more are addicted. It is a public health crisis that has penetrated into every community in the Commonwealth.

I have been practicing family medicine in Worcester for many years, so I know that physicians will never abandon patients who are in pain. I also know that those same physicians are committed to doing everything in their power to end the overdose crisis.

We recognize that opioid medications may lead some people to addiction. That’s why I’m calling on physicians to carefully assess addiction risk before prescribing, and then to prescribe the smallest possible dose of pain medications, for the shortest period of time possible.

I’m also encouraging patients everywhere to have open, candid conversations with their doctor about opioids. If you’re concerned, it’s OK to ask about the risks, as well as the benefits. It’s also OK to ask whether alternatives to opioids would be effective for you.

Addiction is a chronic disease that can be difficult to overcome. Patients in its grip often struggle with relapses, and can be discouraged by the challenge of maintaining their recovery. Ending this epidemic will not be easy.

However, we can beat this if we all work together. One important starting point is to prevent addiction before it starts. Your doctor stands ready to help you.

Sincerely,

Dennis M. Dimitri, MD

President, Massachusetts Medical Society

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

Posted in Department of Public Health, Drug Abuse, Health Policy, opioids, Public Health on November 3rd, 2015 by MMS Communications – 1 Comment

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.

Curbing opioid abuse: A little time can go a long way, experts say

Posted in Drug Abuse, opioids on October 5th, 2015 by MMS – 3 Comments
Wilson Compton, MD

Wilson Compton, MD

By Debra Beaulieu-Volk, Vital Signs Staff Writer

Speakers at Friday’s Opioid Misuse and Addiction Summit at MMS Headquarters each brought varied backgrounds and expertise, but they all had one mission in common: to talk strategy about how to effectively aid patients suffering from addiction and prevent new dependencies from forming.

All experts, including keynote speaker U.S. Attorney Loretta Lynch, emphasized the importance of a collaborative, multi-faceted approach to conquering the chronic disease of addiction. A secondary theme that emerged surrounded the notion of time.

Physicians are not widely reimbursed for spending extra time talking with or on behalf of patients, panelists noted. But with the devastating magnitude of opioid addiction and drug-related deaths, the stakes are too high not to invest more in certain critical moments.

Change the “quick fix” culture

One place to start, experts agreed, is in reducing the amount of prescription opioid medication in our environment. Many who misuse these pills obtain them not from doctors, but from friends and family members, with and without their knowledge, noted Wilson Compton, MD, MPE, Deputy Director of the National Institute on Drug Abuse. These pills would be harder to access if doctors prescribed them less often and in smaller amounts when they do, and if patients were better educated about how to store and dispose of unused medications safely. View Dr. Compton’s slides. (.pdf, 11 pages)

Curbing painkiller prescriptions will require a change in the United States’ current “quick fix culture,” said Maura Healey, Massachusetts Attorney General, noting that prescribing of opioids has grown exponentially in the last 15 to 20 years.

Pressed for time, it has become normalized for physicians to reach for a prescription pad rather than exploring alternative treatments to chronic pain. Thus dynamic must change, experts urged, with special attention paid to patients identified as high-risk for dependence.

Take advantage of the PDMP

Law enforcement officials pointed to the utility of the state’s prescription drug monitoring program (PDMP) as a tool to identify and thwart doctor-shopping. “The tool is right there. PDMP is a great opportunity to hit that one little button and find out what else has been prescribed,” said George Zachos, Chief of Medicaid Fraud Unit and Massachusetts Assistant Attorney General. “If the physicians and pharmacists are using [the PDMP] properly, it should never get to us.”

Identifying a potential case of addiction, diversion, inappropriate prescribing, or other misuse is, as with all elements discussed, just a piece of the puzzle. Most physicians and pharmacists don’t currently have the tools to take the next step and have difficult conversations with patients, panelists noted.

Engage and educate patients

But the common practices of firing the patient or simply refusing to prescribe perpetuate the problem, not just failing to address underlying addictions but upping the chances patients will turn to heroin to self-medicate. Rather, experts advise using the opportunity to engage patients and offer or refer treatment for substance disorders as soon as possible.

When patients aren’t motivated to get help for addiction, physicians should communicate similarly to how they would with someone not managing his or her diabetes, said Sarah Wakeman, MD, leader of an initiative to address opioid addiction at Massachusetts General Hospital. “Often people are ambivalent. It’s our job to tip those motivational scales,” she said. “There are opportunities when people very much do want help, which is why having help immediately available is so important.”

There are times, of course, when the benefits of opioid treatment outweigh the risks, and a prescription is helpful and appropriate for the patient. But many, if not most, devastating addictions begin with a legitimate short-term prescription, experts noted. Therefore, physicians and pharmacists should be sure not to miss this critical opportunity to educate patients, according to Nancy Coffey of the U.S. Drug Enforcement Administration. She told physicians and pharmacists: “Take the extra 10 seconds to advise patients, ‘This is powerful. Treat it that way. Put it where no one will have access.”

Related Content from the Opioid Summit

Narcan offers immediate life-savings, opportunity to engage addicts long-term

Posted in Drug Abuse, opioids on October 5th, 2015 by MMS – 2 Comments

L to R: Sarah Wakeman MD, Jeffrey Baxter MD, Ruth Potee MD, and DPH Commissioner Monica Bharel, MD.

By Debra Beaulieu-Volk, Vital Signs Staff Writer

“We need to keep patients alive long enough to treat them,” Sarah Wakeman, MD, of Massachusetts General Hospital, told attendees of the MMS’ Opioid Misuse and Addiction Summit held last Friday.

A key tool in the state’s arsenal to make addiction recovery possible, experts agreed, is the overdose-reversal drug naloxone, better known by its brand name Narcan. Timely administration of the drug is credited with saving 5 million lives throughout the Commonwealth, according to Monica Bharel, MD, Massachusetts’ Public Health Commissioner.

Although treating acute respiratory emergencies due to overdose is just one piece of the opioid epidemic puzzle, it allows “an opportunity to engage a person who is battling the disease of addiction,” Bharel said.

According to expert panelists, positive steps toward optimizing this opportunity in Massachusetts include the following:

  • The creation of standard orders to make naloxone available at pharmacies without a prescription, not just for patients using opioids but also to secondary individuals such as patients’ family and friends.
  • Distributing naloxone toolkits as standard equipment on law enforcement toolkits. Massachusetts has been a groundbreaking leader on this front, said U.S. Attorney Loretta Lynch. “They can’t always be there [to respond to an overdose], but we can take steps to ensure law enforcement is prepared,” she said.
  • Maintaining reasonable cost to supply and replenish supplies of the drug to first responders and hospitals. “We never want cost to be a barrier to somebody’s ability to access lifesaving medication like that,” stated Maura Healey, Massachusetts Attorney General.
  • Ensuring people carrying Narcan, in either injectable or nasal form, receive proper training. Ideally, at-risk patients or caregivers would receive initial administration instructions in the physician office where the drug is prescribed, followed up with training by a pharmacist filling the prescription, provided that a private consultation area is available, experts said.

Although many overdoses occur when victims are alone, having medication such as Naloxone available is similar to keeping a fire extinguisher in one’s home, said Samuel Penta, RPh, senior investigator with the MA Board of Registration in Pharmacy. “You may never need it, but it will be there if you do,” he said.

Of course, immediate lifesaving doesn’t ensure a person’s long-term freedom from addiction. But use of modalities including medically assisted treatment, behavioral therapy, and other resources can begin as early as a trip to the emergency room, physician experts said.

“This puts the onus on the healthcare system,” Wakeman said. “We don’t have to wait for people to hit bottom. We have treatments that work and need to stat them as soon as possible.”

Related Content from the Opioid Summit

AG Lynch: Cooperation Between Law and Medicine Key to Opioid Fight

Posted in Drug Abuse, opioids on October 2nd, 2015 by Erica Noonan – 2 Comments

By Erica Noonan, Vital Signs Editor

WALTHAM — U.S. Attorney Loretta Lynch said collaboration and cooperation among law enforcement and medicine is the key to progress in battling the epidemic of opioid addiction.

She delivered the keynote address at Friday’s Opioid Misuse and Addiction Summit at MMS Headquarters, a gathering of hundred health care leaders, physicians, law enforcement officials, substance abuse experts, pharmacists,  and patients.

“This is a vital public health issue that was for far too long seen only through the lens of law enforcement,”  she said. “As physicians, you see the true human cost of these addictions.”

She described the four points of the White House approach: enforcement, disposal, monitoring, and education. “We are disrupting the distribution channels… and building cooperation and communication between agencies, and integrating DEA (efforts) with other agencies.”

Because prescription drug abuse is a common precursor to abuse of heroin, a federal multi-agency Heroin Task Force will bring a plan to Congress by years end, Lynch said.

A recent four-state drug bust netted 220 arrests, including 22 physicians and pharmacists, she said. National drug drop-off programs have grown in popularity and effectiveness; the past nine events collected more than 5 million pounds of medication.

“We do have reasons for optimism. We can strengthen families and save lives,” said Lynch. “This is about mending the basic fabric of our communities.”

Related Content from the Opioid Summit

MMS, Medical Schools, Governor Join in Opioid Abuse Battle

Posted in Department of Public Health, Drug Abuse, opioids, Public Health on September 3rd, 2015 by MMS Communications – Comments Off on MMS, Medical Schools, Governor Join in Opioid Abuse Battle

MMS President Dennis M. Dimitri, M.D.

Taking another step in the battle against opioid abuse in the Commonwealth, the Massachusetts Medical  Society, along with representatives from the state’s four medical schools, met yesterday with Governor Charlie Baker and Commissioner of Public Health Monica Bharel, M.D., to discuss a physician-led approach in developing training and best practices for medical students on pain management and safe opioid prescribing.

Providing physicians with additional training on opioids was part of the comprehensive set of 65 recommendations released in June by the Governor’s Opioid Working Group. Yesterday’s meeting was a collaborate effort by the Governor, the Department of Public Health, and the state’s leading physicians to develop that recommendation.

MMS President Dennis M. Dimitri, M.D. described the meeting as one filled with a “spirit of cooperation and positive energy about what we can do working together” to continue the battle against opioid abuse.

Continuing medical education on opioids and pain management has been a prime focus of MMS in its efforts to help curb opioid abuse. In May, MMS issued its Opioid Therapy and Physician Communication Guidelines, offering evidence of best practices for prescribing and made its continuing medical education courses on opioids and pain management free to all prescribers. These courses have been accessed more than 3,200 times.

In a press conference following the meeting, Governor Baker said he was “pleased with the quality of the dialogue” and saw the meeting as the first of several discussions with physicians about their role in addressing the opioid epidemic. “Everybody’s got a role to play,” said Baker, “and we can’t move fast enough” in the fight.

DPH Commissioner Bharel said the meeting resulted in agreement to develop core competencies to educate future doctors on safe prescribing and pain management.

In offering the physicians’ perspective, Dr. Dimitri said physicians constantly face the “challenge of patients with ongoing pain, but the pressure of time, inadequate systems to help the physician and patient deal with pain, and the lack of alternative methods of pain relief covered by insurance put physicians in a tight box” where options to relieve pain were limited and the choice of opioids seemed the most appropriate one.

Dr. Dimitri added that doctors now recognize the impact of the number of opioids in the community and that too many have been allowed to be prescribed. Pledging MMS support of the Governor’s effort, Dr. Dimitri said “we’re very glad to participate in this process.”

MMS commitment to the effort was evidenced by the presence at the meeting of its top three officers – Dr. Dimitri, President-Elect James Gessner, M.D., and Vice President Henry Dorkin, M.D. – and Executive Vice President Corinne Broderick. The medical schools were represented by Karen Antman, M.D., Dean of the Boston University School of Medicine; Harris A. Berman, M.D., Dean of the Tufts University School of Medicine; Terence R. Flotte, M.D., Dean of the University of Massachusetts Medical School; and Todd Griswald, M.D., Director of Medical Student Education in Psychiatry at Harvard Medical School.

Selected press coverage is available here: Boston Herald, MassLive.com/The Republican, WCVB-TV.

The President’s Podium: Being Part of the Solution

Posted in Drug Abuse, Health Policy, opioids, Public Health on July 31st, 2015 by MMS Communications – Comments Off on 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.