Public Health

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: Physicians and Gun Violence

Posted in Public Health on June 16th, 2016 by MMS Communications – 1 Comment

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

Yet another mass shooting has stunned the nation, this time in Orlando, Gessner CropFlorida leaving 49 people dead and another 50 injured.  The home of Walt Disney World and the destination of thousands of tourists each year is now the site of the largest mass shooting in the history of America, joining such names as Columbine, Virginia Tech, and Sandy Hook, along with more than a hundred other places.

Such events are becoming all too common.  According to Everytown for Gun Safety, 133 mass shootings in 39 states occurred in the U.S. between January 2009 and July 2015 – almost two per month.  Yet as horrible and shocking as they are, mass shootings – defined by the FBI as any incident in which at least four people were murdered with a gun – account for a small share of firearm homicides.

The Centers for Disease Control estimates that more than 33,000 deaths from firearms – about 91 a day on average – occur each year.

The statistics make it abundantly clear: gun violence is a public health issue. And the physician’s voice – ever so critical on matters of public health – must become stronger.

The MMS stance on this issue has been firm and long-standing. Our medical society’s policy on firearms and gun violence is expansive and dates back to 1995. It is guided by “the principles of reducing the number of deaths, disabilities, and injuries attributable to guns; making gun ownership safer; promoting education relative to guns, ammunition, and violence prevention for physicians and other health professionals as well as for the public; and encouraging research to understand the risk factors related to gun violence and deaths.”

Our actions have matched our policy.  Our Committee on Violence Intervention and Prevention, also established in 1995, has provided a number of resources to help reduce violence in many forms, and gun violence has been prominent among the topics.

From testimony on proposed legislation on Beacon Hill, to education for patients, to resources for physicians on talking with patients, to our most recent Public Health Leadership Forum on Firearm Violence in April, to then-MMS President Dr. Richard Aghababian’s call to action following the school shootings in Newtown in 2012,  gun safety and gun violence have been key issues for our Society.

It is heartening to see more physician groups lend their strong support to the effort.  The American Medical Association, with longstanding policies on reducing violence from firearms, stated its position at this year’s annual meeting, adopting a policy calling gun violence in the U.S. “a public health crisis” that requires a comprehensive public health response and solution.  Perhaps most important, the AMA also resolved to lobby Congress to overturn legislation that for 20 years has banned the Centers for Disease Control and Prevention from conducting research on gun violence.

A second resolution by the AMA on firearm availability encourages legislation that would enforce a waiting period and background check for all firearm purchases and urges additional legislation to ban the manufacture, sale, or import of lethal and non-lethal guns of non-metallic materials that can not be identified by weapons detection devices.

In April of 2015, seven physician organizations, along with the American Public Health Association and American Bar Association, issued a call to action, declaring that “deaths and injuries related to firearms constitute a major public health problem in the United States.”

I am proud to say that more efforts at our medical society are underway. Our Leadership Forum will provide materials for six continuing medical education courses on gun violence to launch at the end of June.  Among the topics will be the role of the clinician, community-based prevention, and evaluating the risk for gun violence in patients.  Additionally, we are participating with Massachusetts Attorney General Healey in developing materials to enhance the provider-patient relationship regarding firearms.

The shock of Orlando may fade over time, but physician efforts to reduce gun violence should not.  Attorney General Healey, speaking at our Leadership Forum, highlighted the importance of physician participation in curbing gun violence, saying it will require a “partnership” with physicians.  Indeed it will.

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

 

 

June Physician Focus: Infectious Disease: Fear vs. Evidence

Posted in Ebola, Flu, H1N1, Physician Focus, Public Health on June 10th, 2016 by MMS Communications – Comments Off on June Physician Focus: Infectious Disease: Fear vs. Evidence

The outbreak of an infectious disease is one of medicine’s most difficult challenges.  At the same time that public health agencies must contain the infection, they must also try to quell the public’s fears – a difficult task in today’s world of instant communication, multiple media channels, and constant media attention.  The experiences of Severe Acute Respiratory Syndrome in 2003, H1N1 Bird Flu in 2009, Ebola in 2014, Middle East Respiratory Syndrome in 2014, and now the Zika virus in 2016, are the most recent examples of threats targeting the public health.

June Physician Focus features Dr. Steven Hatch (r), with host Dr. Bruce Karlin

June Physician Focus features Dr. Steven Hatch (r), with host Dr. Bruce Karlin

The June edition of Physician Focus provides some perspective on the topic of media and public reaction to outbreaks of infectious disease through the experiences of Steven C. Hatch, M.D., an infectious disease specialist at UMass Memorial Medical Center and an Assistant Professor in the Division of Infectious Disease at UMass Medical School in Worcester. Hosting this edition is Bruce Karlin, M.D., a primary care physician in Worcester.

In 2014, Dr. Hatch spent five weeks in Liberia with the International Medical Corps treating patients stricken with Ebola and subsequently returned to that country several times to treat patients. Among the topics of conversation are what public health agencies must consider in reacting to infectious disease outbreaks, comments on how the media covered the Ebola outbreak in the U.S., and Dr. Hatch’s perspective on the latest outbreak of Zika.

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/disease2016, and on YouTube.

 

Q&A with Dr. Catherine Brown of the Massachusetts DPH: What Physicians and Patients Should Know About Zika

Posted in Department of Public Health, Public Health on June 8th, 2016 by MMS Communications – Comments Off on Q&A with Dr. Catherine Brown of the Massachusetts DPH: What Physicians and Patients Should Know About Zika

Editor’s Note: Last week, the Massachusetts Department of Public Health posted new clinical guidance for physicians about the Zika virus on its website, which also includes handouts in multiple languages about the virus and travel advice for patients.

MMS spoke with Catherine Brown, D.V.M., M.S., M.P.H., Deputy State Epidemiologist and State Public Health Veterinarian at the Massachusetts Department of Public Health, about the potential for contracting Zika in the Commonwealth and what physicians and patients need to know.

We’ve seen a lot in the news about the Zika virus.
Should we be concerned about Zika virus in Massachusetts?
It’s extremely unlikely that we’ll see mosquito-borne Zika virus in Massachusetts.  The conditions in Massachusetts are not conducive to mosquito transmission of the virus here. In order for the Zika virus to spread, there needs to be widespread established populations of mosquitos and a significant number of people actively infected with that widespread population of mosquitoes.

Dr. Catherine Brown, Massachusetts Department of Public Health

Dr. Catherine Brown, Massachusetts Department of Public Health

The primary vector of Zika virus, not just in this current outbreak, and in almost all outbreaks, has been the yellow fever mosquito Aedes aegypti. This mosquito is more likely to spread disease because it breeds successfully in urban environments, and bites, almost exclusively, people–it doesn’t feed on other mammals—and unlike other types of mosquito, it takes multiple blood meals. Most mosquitoes take a single blood meal, so are less likely to transmit disease. The Aedes aegypti mosquito has not been found in Massachusetts.

The secondary vector is the Asian tiger mosquito Aedes albopictus. This is a non-native introduced species that is well established in the southern tier of the U.S. It feeds on humans as well as other mammals. There is some evidence, from Massachusetts mosquito surveillance, that we have geographically isolated and sporadic findings of Aedes albopictus. However, as with Aedes aegypti, there would need to be widespread established populations as well as significant numbers of actively infected people in contact with that widespread population of mosquitoes in order to spread the virus.  The people in Massachusetts who have been infected with the virus are travelers returning from affected areas; they don’t carry the virus in their blood for very long.

So the risk for people in Massachusetts relates to those traveling to or from an affected region.  What regions in and out of the U.S. are affected?
As of [this interview], there have been no cases of locally acquired, mosquito-borne transmission anywhere in the United States.  The areas involved in the current epidemic of Zika virus are most of Central and South America and the Caribbean, as well as Cape Verde and Papua New Guinea. The U.S. Territory of Puerto Rico has been particularly hard hit. This is the largest outbreak of Zika virus ever documented, both in terms of number of people infected and the geographic range of the outbreak. Because infection with Zika virus likely confers long-term immunity, previous outbreaks have waned relatively quickly as the percentage of susceptible people in the population declines.

Travelers concerned about the status of the Zika virus should check the CDC website for the most updated information on currently affected areas.

What are the symptoms of Zika?
Eighty percent of people infected with Zika virus will never develop symptoms. For those that do become symptomatic, the most common complaints are fever, a rash, joint pain and non-purulent conjunctivitis. Headache and pain behind the eyes have also been reported. For the vast majority of people, the illness lasts between two to seven days and is self-limiting. No specific treatment exists. Hospitalizations associated with Zika virus infection are rare but have been associated with Guillain-Barré, meningoencephalitis, and other neurologic problems.

It is not known if there are particular groups of people that are more likely to develop disease, or who are more likely to develop severe disease, including Guillain-Barré.  No evidence exists that pregnant women, infants, or children are at greater risk for developing disease and information about risk in immune-compromised patients is limited.

What is the risk from Zika to humans?
The most significant concern from Zika virus infection is for pregnant women who can transmit the virus to a developing fetus.

Right now, there are still more questions than answers about Zika virus.  We do know that women infected with Zika virus during pregnancy are more likely to give birth to an infant with birth defects or some other poor birth outcome. Exactly how much risk is associated with infection is not known. There is some information that infection with Zika virus during the first trimester, as opposed to later trimesters, is more likely to cause microcephaly in the developing fetus, but poor birth outcomes and other types of birth defects have been reported associated with infection during all trimesters of gestation. Microcephaly has received much of the attention; fetal loss, intracranial calcifications, and hearing and vision defects have also been reported.  It is not known how often vertical transmission –a mother with the virus transmitting it to a fetus—occurs, or how often this results in problems with the developing fetus or the pregnancy.

How should physicians counsel their patients?
Physicians should counsel pregnant women or those who want to become pregnant in the next two months that they really should not travel to areas where there is a reported threat of Zika virus transmission. If they do travel to those areas, they should wait eight weeks after returning before attempting conception.

Sexual transmission from symptomatic males has been documented, so male patients who have been symptomatic for Zika should use condoms consistently and correctly for all sexual contact for six months as a precaution to avoid transmitting the virus to a woman who may be, or may wish to become, pregnant.

What if the male traveled to an affected region, but has not been symptomatic for Zika?
Males who have traveled to an affected region but did not develop characteristic Zika signs and symptoms should use condoms consistently and correctly for all sexual contact for eight weeks after their last possible exposure.

If a patient has traveled to an affected area, what does the physician need to know?
Anyone who was pregnant when they traveled, or who became pregnant within eight weeks of returning, should be tested for Zika virus infection whether or not they developed symptoms of Zika.  If the male partner of a pregnant woman traveled to an affected area, testing of the pregnant woman (and sometimes her male partner), is indicated if either one of them develops symptoms of Zika virus infection.

Patients who develop Guillain-Barré syndrome following a Zika-like infection should also be evaluated for testing.

Why shouldn’t everyone who has traveled be tested?
Testing is not as simple as marking a checkbox on a lab test order. There are two types of testing: antigen-based and antibody-based. Whether the patient is symptomatic or asymptomatic, and the timing of specimen collection, determine what type of testing needs to happen. Right now, the commercially available, antigen-based test is only good for three to four days after the onset of symptoms, so this test is completely inappropriate for patients who have no symptoms. The Massachusetts State Public Health Laboratory has the ability to run both the antigen- and antibody-based tests; preliminary positive results from the antibody test require confirmation which is currently being done by CDC. Clinicians should check the Mass. Department of Public Health clinical advisory (found under the section, “Information for Health Care Providers” on the MDPH’s Zika website) to ensure they’re ordering the appropriate test for the patient.

Physicians should also keep in mind that it’s possible that pregnant women returning from the affected regions to Massachusetts to deliver their babies here have received virtually no prenatal care, and probably haven’t been tested previously for Zika. The pediatrician may be the first health care provider to recognize that Zika is involved. Physicians should call the MDPH Epidemiology Line at 617-983-6800 to determine if testing is recommended.  When Zika virus testing is appropriate, the results can help to inform the provider’s clinical decision-making and help to provide answers to parents.

Is the Department of Public Health tracking these cases?
Yes. While no single state is going to have enough data to draw all conclusions that we need to draw in order to guide clinical and prevention practices, individual states are collecting de-identified data from OB/GYN providers on pregnant moms with lab verified exposure to Zika virus. Additionally, states are working with pediatricians to follow the infants for 12 months after birth as part of participation in the U.S. Zika Pregnancy Registry being operated by CDC. Most information on the pregnant women can be collected during routine phone calls with OB/GYN providers to discuss laboratory testing and to share results. The Massachusetts Center for Birth Defects Research and Prevention within MDPH is aiding this effort by providing information on both the mother and the initial neonatal assessment as part of their routine work identifying infants with birth defects.  MDPH will work with individual pediatricians to gather the requested data in as unobtrusive a manner as possible. We have been delighted by the positive relationships being developed with providers who understand the importance of collecting this information. By collecting information on the progress of pregnancies and serial assessments of infants’ health, we hope to rapidly and completely identify both the risks of infection during pregnancies and the spectrum of possible effects to infants that might include more subtle developmental problems.

 

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.

Mass. AG Maura Healey: Gun Violence is a Public Health Crisis

Posted in gun control, Public Health, Public Health Leadership Forum on March 31st, 2016 by Erica Noonan – Comments Off on Mass. AG Maura Healey: Gun Violence is a Public Health Crisis

Massachusetts Attorney General Maura Healey will speak to leaders in public health and medicine at MMS’s Public Health Leadership Forum on Firearm Violence on April 5.  MMS Public Health Manager Robyn Alie spoke with Attorney General Healey recently about firearm violence and how it affects physicians and the public.

MMS:  You have called the epidemic of gun violence a public health problem. Why?

AG HEALEY: I think what’s really important is we talk about this as a public health crisis and as a moral issue for our country.   In far too many places, across this country, people are fearful of sitting outside on their porch, fearful of letting their kids walk to school. We have too many victims of domestic violence, subject to incredible mental anguish given that their abusers have guns and are able to wield all sorts of power.

Guns have a significant impact on the health and wellbeing of families and of the community at large. The fact of the matter is that having a gun in your home does not make it a safer place to be, and actually makes it more dangerous. It’s not that people aren’t entitled to exercise their second amendment rights and to keep a gun at their house, but the risk of suicide is five times as high. Death of a household member is three times more likely. With a gun in the home, a woman’s risk of intimate partner homicide is seven times as great.

MauraHealey42

MMS: Last year, a physician at Brigham and Women’s Hospital was fatally shot by a patient’s family member. What are your thoughts about how to protect health professionals?

AG HEALEY: It was so tragic. He was shot to death in the hospital doing his job. In the wake of that event, we reached out to the hospitals to find out how we can be helpful, and we learned that hospitals need to find the right balance, between providing secure spaces for their workers and patients, and at the same time providing a place that’s welcoming and inviting for family members and for visitors, and it’s tough. It’s a delicate balance, and one that requires the use of best protocols and policies to ensure that no one’s in harm’s way.

But I still see instances where the availability of guns has made it far too easy for someone who’s set on doing harm to obtain guns and be able to go out and cause harm.

MMS:  We have seen that mental health is often implicated in gun violence events, but research has shown that the proportion of gun violence perpetrated by people with mental illness is actually quite small, and those with mental illness are actually more likely to be victims. What are your thoughts about policies related to mental health and gun violence?

AG HEALEY: I would never want our gun violence blamed on mental health problems. We shouldn’t use this issue to create greater stigma around mental health and behavioral health. But, I think it is an opportunity to recognize that those services need to be more robust. That’s why we need true mental health parity when it comes to coverage and access. We need to focus on the reality that 62% of gun deaths are suicides. Also, we do need to provide care and treatment to those folks. How are we looking to intersect with them so that we have an opportunity to intercede? Again, here’s where I think health care and medical professionals have that opportunity. And why their involvement and engagement are so important. Because we should be doing everything we can to make sure that people who are a danger to themselves or a danger to others, who might harm themselves are not able to access guns in a way that’s going to enable them to harm themselves or someone else.

MMS: What about issues of patient privacy?

AG HEALEY: It’s an issue where I know there has been some differences across the states. There’s a law in Florida that actually prohibits physicians from asking their patients about gun ownership. That law is now being challenged in the courts. And I think it should be challenged for all the reasons we just talked about. Gun violence is a public health issue and I don’t think that doctors should be restricted from asking their patients about an issue that could affect their health. The NRA has long pushed for these kinds of laws in part because they know how influential physicians can be. I think that’s where we need to have doctors more involved in addressing this question. I don’t think doctors should be in any way prohibited from asking patients about an issue that in any way could affect their health. This is one. Obviously there are appropriate ethics that apply when it comes to physicians becoming aware that someone may do immediate harm to themselves or others, and they should act appropriately there, according to their ethical obligations.

Learn more about the 12thAnnual MMS Public Health Leadership Forum, Firearm Violence: Policy, Prevention & Public Health, on April 5 from 1:00 to 5:00 p.m.

 

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.

February Physician Focus: Concussions

Posted in Physician Focus, Public Health on February 24th, 2016 by MMS Communications – Comments Off on February Physician Focus: Concussions

The severity and potential of long-term health effects of concussions are now recognized at all levels of sports, from the professional ranks to youth leagues.

To add to the public awareness of this injury, the February episode of Physician Focus features Dr. Ann McKee (photo, seated), Chief of Neuropathology at the VA Boston Healthcare System, Professor of Neurology and Pathology and Director of the Chronic Traumatic Encephalopathy Center at the Boston University School of Medicine, and one of the nation’s foremost experts on the effects of concussion and head trauma. Hosting this edition is Dale Magee, M.D. (photo, standing), a past president of the Massachusetts Medical Society.

While acknowledging the multiple benefits that young people gain by participating in sports, Dr. McKee offers valuable, basic information on what she characterizes as an “invisible injury,” one that carries no recognizable signs of harm such as bleeding or pain.

The conversation includes information on many aspects of the injury: its symptoms, difficulty of diagnosis, what to do with a player when a concussion is suspected, gender differences in susceptibility to the injury, as well as the dangers of second and multiple concussions, “sub-concussive” impacts to the head, and the development of “skill sets” by athletes to reduce the risk of concussion in sports.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and online at www.physicianfocus.org, www.massmed.org/physicianfocus, and YouTube.