Governor’s Opioid Task Force: A Smart, Comprehensive Approach

Posted in Drug Abuse, opioids on June 22nd, 2015 by MMS – Comments Off on Governor’s Opioid Task Force: A Smart, Comprehensive Approach

By Dennis M. Dimitri, MD
MMS President

Dr. Dennis Dimitri 300 ppiWe welcome today’s report from the Governor’s Opioid Working Group. It is a smart, comprehensive approach to an extremely complex problem, and we pledge to pledged to continue to work with public and private officials to combat the opioid overdose epidemic.

We appreciate that the working group addressed many of the issues we have discussed with the Governor Baker, Attorney General Healey, Secretary Sudders and their staffs. We agree that because of the opioid crisis, we need a different approach to the prescribing and management of opioid medications. That is why we’ve taken a proactive approach to the issues, and launched a comprehensive program to educate physicians, other prescribers and the public last month.

We especially support the recommendations to improve the state’s online prescription monitoring program; increasing access to naloxone by encouraging it to be co-prescribed with opioid medications; allowing the partial filling of opioid prescriptions without additional co-payments; expanding education for prescribers and the public; expanding access to intervention and treatment; and taking steps to destigmatize addiction.

Our program to fight opioid overdoes, called “Smart Scripts MA,” was launched in May 2015. It has three components:

Prescribing Guidelines: The guidelines are designed to help physicians make the right decisions for their patients. They were developed by a task force of physicians from a broad range of specialties, and derived from similar work conducted in other states and by several state and national medical specialties.

The guidelines first emphasize that physicians and patients should discuss family and personal histories of substance abuse disorders and behavioral health concerns, before the prescription is written. The guidelines also encourage patients and physicians to mutually develop agreements that outline the expectations and goals of the treatment, along with the conditions for continuing opioid therapy after initial treatment.

Free Education in Pain Management: The MMS has made its online medical education courses in pain management available free to all prescribers until further notice. Five courses are currently available; several more courses will be published later this week, and more courses are planned for later this year. These courses are available for Continuing Medical Education credit. Physicians have been required to obtain CME credits on this topic as a condition of licensure and re-licensure since January 2012.

Public Education Program: The MMS has also launched a public education program to inform patients and their families about the safe storage and proper disposal of their opioid medications, in an effort to reduce the supply of medications in the community. According to the CDC, more than 80% of people who abuse prescription drugs are using medications that were prescribed for someone else. Safe storage and disposal will reduce or eliminate this source of misused prescription medications.


Bold Steps to End the Opioid Epidemic – The Physician Contribution to the Solution

Posted in Drug Abuse, opioids on May 21st, 2015 by MMS – 5 Comments

Dr. Dennis Dimitri By Dennis M. Dimitri, MD
President, Massachusetts Medical Society

An epidemic of opioid use and the associated overdose deaths has been slowly building across the nation and Massachusetts for the last decade, and has now reached a crisis point. It is affecting nearly every city and town in the Commonwealth. In some communities, the crisis is unprecedented.

State officials estimate that more than 1,000 Massachusetts residents died of opioid overdoses last year – 33% percent more than in 2012, and nearly three times more than in 2000.

A Harvard School of Public Health survey found that nearly 4 in 10 state residents personally know someone who has abused prescription pain medications.

While the total numbers may be startling, we should also remember that each individual overdose death has a human face. Each tragedy has changed a family forever. It has to stop, and the time for action is now.

Physicians must step forward immediately to do everything we can to help bring this devastating problem under control. How can we do this? It starts with education.

According to the Centers for Disease Control and Prevention, more than 80% of people who misuse prescription pain medications are using drugs prescribed to someone else. These drugs are most often obtained from a friend or relative – for free, purchased, or stolen.

This tells me that there are too many doses of opioid medications in circulation. By limiting this supply and ensuring that opioids are available only to patients who truly need them, we can make a big impact on the Commonwealth’s opioid crisis.

That is why the Massachusetts Medical Society is launching a comprehensive campaign to educate prescribers and the public about the safe and responsible prescribing and handling of these medications.

The campaign has three components:

  • Guidelines to help physicians make the right decisions for their patients
  • Free education resources for prescribers to help inform their judgments
  • Storage and disposal information for patients and their families

Prescribing Guidelines

We have reviewed guidelines already developed by many states and medical specialty societies on this topic. There has been a lot of good work done in the area already – it is, after all, a national epidemic. We are recommending this set of guidelines for use by all physicians.

They are not designed to micromanage care, but to provide guidance and information based on evidence that will improve the care of our patients and lessen the risks associated with opioid prescribing. At the same time we recognize that each patient is different, and in all cases, a prescriber’s sound clinical judgment is important. However, we also believe that several principles should govern the exercise of this clinical judgment.

First, the guidelines emphasize that physicians and patients should discuss family and personal histories of substance abuse disorders and behavioral health concerns, before the prescription is written.

Second, patients and physicians are encouraged to mutually develop agreements that outline the expectations and goals of the treatment, along with the conditions for continuing opioid therapy for chronic pain after initial treatment.

Third, there are exceptions for hospitalized patients, those in hospice and palliative care, and for those being treated for cancer. These patients have special circumstances that do not yield readily to hard and fast rules. Their care must be based upon the long held medical principles of relief of suffering.

We’re offering these guidelines with the hope that they will be adopted by physician practices throughout the state. We are also sharing them with the state Board of Registration in Medicine, in the event that the Board will consider incorporating them into its prescribing guidelines for physicians.

You can see the details of our recommendations here.

Prescriber Education

The Massachusetts Medical Society has long been a leader in providing continuing medical education to physicians and other clinicians about pain management. Today, we are announcing that we are making these pain management courses available to all prescribers – for free, until further notice. This includes not only our current suite of courses, but those currently in the pipeline that are due to be released in the coming weeks and months.

The urgent interests of the community are paramount, and we will remove as many barriers to this prescriber education information as possible.

Public Education

An effective first step to reduce non-medical opioid use is through education. Therefore, in an effort to curb the supply of prescription opioids in the community, we are partnering with the Partnership for Drug Free Kids and its Medicine Abuse Project to broadly disseminate information about the safe storage and proper disposal of opioid medications.

Most people are probably unaware that their medicine cabinets are attractive targets for those who would misuse opioids, and that they could be an unwitting supplier. Our education program will provide guidance on how to safely store and secure medications, and how to get rid of them when they are no longer needed.

In early June, our website will host all of these materials. We will make these materials available to anyone, including physicians, who wish to put them in their offices or share them electronically.

There is no more important public health issue today than the opioid epidemic. It is devastating communities, families, men, women, rich and poor, and most tragically, children and adolescents. It has to stop – and we are ready to do our part.

2015 Shattuck Lecture: CDC’s Dr. Tom Frieden on the Current and Future States of Public Health

Posted in Annual Meeting 2015, Drug Abuse, HIV, opioids, Public Health on May 2nd, 2015 by MMS Communications – Comments Off on 2015 Shattuck Lecture: CDC’s Dr. Tom Frieden on the Current and Future States of Public Health

Describing public health as the means that will “account for most of our health progress in the years to come,” Director of the U.S. Centers for Disease Control Dr. Tom Frieden spoke of the achievements and challenges in public health in delivering the 2015 Shattuck Lecture at the Massachusetts Medical Society’s annual meeting on Friday, May 1.

In a talk that was both entertaining and instructive and supported with statistical data, Dr. Frieden touched on a myriad of subjects, including antibiotic resistance, the opioid epidemic, the state of HIV care, tuberculosis, the impact of vaccines, the threats and improvements in cardiovascular care and hypertension, the continuing and new dangers of tobacco and nicotine delivery systems such as e-cigarettes, and the public health actions of a responsive government.

Among the highlights from his address:

On infection and the spread of drug-resistant bacteria: “The obsession to increase the population impact of our efforts is routinely complicated by infection, which could eventually undermine much of modern medicine. Our Antibiotic Resistance Initiative could reduce many infections over the next five years.”

On clinical care working with public health: “The intersection of clinical health care and public health is one of the essential concepts that underlie public health, and all too often they are going in different directions. There’s a lot we can learn from each other.”

On the Ebola crisis: “We learned two big lessons from the Ebola crisis. Every country needs to have a core public health capacity and the world has to move faster with outbreaks and epidemics.”

On the role of government: “The appropriate role of government is getting people to make healthy choices, with free and open information, by protecting individuals from harm caused by others, and by taking societal action to protect and promote health. These are the public health actions of a responsive government.”

On the responsibilities of individuals, providers, and government: “Until we have a collective responsibility for health-inducing environments, we will continue to have challenges.”

On the main goal of the CDC: “The goal of the CDC is a safer U.S and a safer world, to prevent avoidable catastrophes, to detect threats early, and to respond rapidly and effectively.”

Slides from Dr. Frieden’s presentation are available here.

A video of the full talk is available here:

MMS Ethics Forum Examines Pain Management

Posted in Annual Meeting 2015, Ethics Forum, opioids on April 30th, 2015 by MMS – 1 Comment

The opioid epidemic continues to grow, here in Massachusetts as well as the nation.  In its latest tally, the state has recorded more than 1,000 opioid-related deaths in 2014, 33 percent higher than just two years earlier.

In announcing the figure on Wednesday, Governor Charlie Baker cited research showing that four out of every five heroin addicts got hooked on opioids through pain medications, many starting with legally prescribed medicine, according to a report by The Boston Globe.

While some point to the overprescribing by physicians as part of the problem, the opioid epidemic – and what can be done to reduce the abuse – has been a priority topic for physicians. The MMS’s 2015 Public Health Forum focused on the topic, and Dr. Richard Pieters’ President’s Report to MMS members delivered earlier today recounted some of the Society’s accomplishments in addressing the issue.

Today’s MMS Ethics Forum continued the Society’s emphasis on the topic. Presented by the Committee on Ethics, Grievances, and Professional Standards, the 2015 forum explored the ethical and legal consideration in pain management. Among the topics included were responsible prescribing, the complexity of pain as a clinical issue , and the ethical problems associated with undertreatment and overtreatment, and the balance between a physician’s obligations to the patient and obligations to public health.

Participants include Seven Adelman, M.D., director of Physician Health Service; Dr. Richard Pels, Director of Graduate Medical Education at Cambridge Health Associates; and Mark Eisenberg, M.D., Unit Chief of Adult Medicine at Massachusetts General Hospital-Charlestown Health care Center.

Visuals from the presentations may be viewed here.

Mass. Attorney General’s Office: Medical Community Is Part of the Solution

Posted in opioids, Public Health, Public Health Leadership Forum on April 8th, 2015 by MMS – Comments Off on Mass. Attorney General’s Office: Medical Community Is Part of the Solution

Massachusetts Attorney General Maura Healey has made prescription drug abuse a top priority for her office, and First Assistant Attorney General Christopher K. Barry-Smith’s message to Forum attendees was that Ms. Healey views the medical community as a “large part of the solution” to the problem of opioid abuse.

Barry-Smith said Ms. Healey decided on making opioid abuse a priority for her office as a result of her campaign for the office last year. In talking to citizens across the state, Healey discovered a recurring theme of concern from individuals and families: that drug and opioid abuse was a serious problem and something must be done about it.

Establishing opioid abuse as a priority, Barry-Smith said, takes three avenues of approach:  heroin trafficking, prescription drug trafficking, and unlawful prescribing, the last of which he said was a “small part” of the problem. He also noted that the Attorney General’s office would act to ensure that pharmaceutical marketers and dispensers take reasonable steps to reduce the risks of diversion and abuse.

Christopher K. Barry-SmithThe pricing of the anti-overdose drug naloxone and insurance coverage for behavioral health parity are other major concerns of the Attorney General, Barry-Smith said, as is the prescription monitoring program, “to make it as useful as possible.”

Finally, Barry-Smith, reprising the theme that the medical community is seen by the Attorney General as part of the solution, said that prescribing practices must take into account the possibility of overdose and he urged prescribers to “follow best practices.”

— Richard Gulla

Public Health Forum Keynote: Opioid Abuse Is a Public Health Issue

Posted in opioids, Public Health, Public Health Leadership Forum on April 8th, 2015 by MMS – Comments Off on Public Health Forum Keynote: Opioid Abuse Is a Public Health Issue

Combining raw statistics with the faces of real people who have died from drug overdoses, and at the same time reflecting on his personal experience with substance abuse, Michael Botticelli took a decidedly human approach in his address at the 2015 MMS Public Health Forum, The Opioid Epidemic: Policy and Public Health. 

Botticelli, Director of the Office of National Drug Control Policy and former Director of Substance Abuse Services for the Massachusetts Department of Public Health, provided the keynote speech at the forum, which featured a range of experts discussing the medical, clinical, and legal aspects of opioid abuse.

Botticelli was clear and direct with two main messages for the 300 in attendance: “Opioid abuse should be regarded as a public health issue” and “we cannot afford to wait as a society to act” in responding to it.

He said five areas must be the focus of efforts by physicians, policymakers, legislators, and law enforcement officials to curb the abuse of drugs: education, prescription monitoring programs, storage and disposal, enforcement, and treatment.

Education: Botticelli noted that physicians receive little training in medical schools on opiates and prescribing and recommended that medical schools begin to establish courses in these subjects and urge, if not require, students to take them.

Michael BotticelliPrescription monitoring: Regarding them as valuable tools for research and to prevent “doctor shopping” by patients, Botticelli said prescription monitoring programs in the states must continue to be modernized and given more funding.  Noting that 49 states now have prescription monitoring programs, with Missouri on the way to becoming the 50th, he urged a nationwide infrastructure for such programs, with interstate data sharing and interoperability among hospitals, clinics, and health centers.

Disposal: Acknowledging data from the Centers for Disease Control that most of those who abuse prescription drugs use drugs that are prescribed to someone else, Botticelli recognized the importance of proper storage and disposal, saying we need to get the drugs “out of the home when no longer needed.”

Enforcement: While prescription drugs constitute a major part of the abuse problem, Botticelli said priority must also be given to the illegal trafficking in heroin.

Treatment: “People can succeed with the right treatment,” he said, and we must make “every effort to reduce the stigma to help people get the care they need.  If we want better outcomes, we need to pay attention to substance abuse disorders.”

Botticelli concluded his remarks with a message for health care providers.  “The medical community must remain engaged,” he said.  “The problem can be cared for by those who can provide the highest levels of care.  We don’t have time to waste.”

The slides for Mr. Botticelli’s presentation are available at www.massmed.org/PHLF2015

— Richard Gulla

The President’s Podium: Reducing Opiate Abuse

Posted in Department of Public Health, Health Policy, Medicine, opioids on February 18th, 2015 by MMS Communications – Comments Off on The President’s Podium: Reducing Opiate Abuse

By Richard Pieters, M.D., President, Massachusetts Medical Society

Governor Charlie Baker and Attorney General Maura Healey have each made opiate abuse one of their top priorities, and this week they will announce steps they will take to fight this public health crisis. That the state’s top elected official and top law enforcement officer have put this issue at the forefront of their agendas is good news, because even as Massachusetts ranks as one of the top four states in adopting strategies to curb prescription drug abuse by the Trust for America’s Health, prescription and opiate abuse remains a crisis in the Commonwealth.

MMS has reached out to both the Governor and Attorney General to offer our assistance as they address the problem. Their initial responses have been encouraging, and we look forward to hearing the specifics of their plans and working with them.

One of the keys to reducing the abuse, however, is a sustained effort in raising public awareness about the issue, and the Massachusetts Medical Society has long recognized the importance of communicating to both physicians and patients about prescription drug abuse.

We highlighted the topic in 2011 with our patient education television program that reaches communities across the state, and in subsequent shows addressed the topic of substance abuse in young people and how they can be treated.

Our current program revisits the subject of prescription abuse with experts in addiction medicine. Additionally, we have distributed articles to local media, to outline what both physicians and patients can do to prevent prescription abuse. This is especially important, as more than three out of four people who misuse prescription pain medicines use drugs prescribed to someone else.

My predecessor Dr. Ronald Dunlap last year outlined the physician’s perspective on prescription drug abuse and recommended additional steps that can be taken to reduce the abuse.

I have since provided my views and recommended improvements in the state’s prescription monitoring program, which the Society helped to create more than 20 years ago. We believe a well-run, real-time, robust monitoring program is a key element in the fight against prescription abuse and one in which every physician should participate.

MMS will continue its educational effort on opioids and prescription abuse on April 8 with our Annual Public Health Leadership Forum for physicians and health care providers. The Opioid Epidemic: Policy and Public Health, featuring local and national leaders in substance abuse and addiction medicine, will discuss a range of issues, including the basics of pain management, alternatives to opioids, communicating with patients about pain management and treatment, and advocacy for treatment programs for those with addictions. This forum will offer important information for those who prescribed opioids and treat pain and addiction, and I urge those who do so to attend.  Also, the MMS Ethics Forum at our annual meeting in May will explore the ethical and legal considerations in pain management by physicians.

As government and public health officials seek remedies to the opiate crisis, we urge them to recognize that physicians and their patients – the ones who treat the pain and take the medicines – can play critical roles in reducing the abuse.

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

February Physician Focus: The Physician’s Perspective on Prescription Drug Abuse

Posted in Drug Abuse, Health, opioids, Physician Focus, Public Health on January 30th, 2015 by MMS Communications – Comments Off on February Physician Focus: The Physician’s Perspective on Prescription Drug Abuse

Health and governmental officials at all levels are struggling with solutions to what has become one of the nation’s most pressing public health problems: prescription drug and opiate abuse.

Addiction experts, public officials, and even some physicians, have pointed to the medical profession as one cause of the problem. Physicians write too many prescriptions, they say.  But the fact that more than three out of four people who misuse prescription pain medicines use drugs that are prescribed to someone else is one indication that the problem arises from more than a single cause.

The February edition of Physician Focus, with a discussion among three physicians knowledgeable about the treatment of pain, pain medications, and opioid abuse, offers the perspectives of physicians on prescription drug and opioid abuse.

Participating in this conversation are Richard Pieters, M.D., (center, photo) President of the Massachusetts Medical Society and Professor of Radiation Oncology and Pediatrics at the University of Massachusetts Memorial Medical Center in Worcester; Daniel Alford, M.D., (right) Director of the Safe and Competent Opioid Prescribing Education program at Boston University School of Medicine and the Director of the Clinical Addiction Research and Education Unit at Boston Medical Center; and Barbara Herbert, M.D., (left) Medical Director of Addiction Service at Commonwealth Care Alliance and President-Elect of the Massachusetts Chapter of the American Society of Addiction Medicine, who serves as host for this program.

All three physicians bring their personal experiences in treating patients with pain to the discussion. Among the topics they address are the physicians’ viewpoints on the causes of opiate abuse; the prevalence of pain as a medical condition; the elements of effective and safe pain management; the distinctions among different kinds of pain; what steps physicians and patients can take, both individually and collectively, to reduce the abuse of pain medicines; and how physicians view the use of the prescription drug Narcan to prevent deaths from overdoses.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus, and on  YouTube.

Walgreens Expands Its “Good Faith Dispensing” Policy

Posted in Drug Abuse, opioids on December 22nd, 2014 by MMS – Comments Off on Walgreens Expands Its “Good Faith Dispensing” Policy

Presciption drugs and stethoscopeIn April 2013, Walgreens Pharmacy notified health care providers across the country of its revised policy for the dispensing of controlled substances.

The letter cited every pharmacist’s corresponding responsibility, along with physicians, to ensure that every prescription for a controlled substance “must be issued for a legitimate medical purpose.”

The letter said Walgreen’s pharmacists would start taking additional steps when verifying certain prescriptions for controlled substances. MMS has heard from several physicians inquiring about this policy.

Walgreens’ policy states: “Our pharmacists are required to take additional steps when verifying certain prescriptions for controlled substances. This verification process may, at times, require the pharmacist to contact you … information requested may vary, potential questions could include information about the diagnosis, ICD-9 code, expected length of therapy and previous medications/therapies tried and failed.”

According to an FAQ provided to the New Hampshire State Medical Society, Walgreens has emphasized that this new policy should not mean calls to prescribers on every, or even most, prescriptions for controlled substances.

Why did this happen?

Over the past few years, the Drug Enforcement Agency (DEA) has increasingly been looking at the problem of narcotics abuse in this country. While the DEA has investigated and prosecuted individual prescribers of prescription narcotics and synthetic opiates, the DEA is also looking at the distributors and dispensers of these prescription drugs.

The DEA has also been visiting states nationwide and presenting an intense power point lecture to help train pharmacists and remind them of their corresponding duty under federal regulations to ensure that each prescription for a controlled substance is issued for a legitimate medical purpose by each individual prescriber.

In response, Walgreens revised its policy on good faith dispensing of controlled substances, using in part “red flags” as determined by the DEA. Walgreens wants its pharmacists to be comfortable when they fill a prescription for controlled substances and the policy lays out suggestions on how to assure that the prescription is legitimate.

Where do things stand?

MMS has worked closely with the AMA in sharing information and gaining a perspective of this problem on the national scale.  The AMA, along with the national medical societies for family physicians, emergency physicians, anesthesiologists, and osteopathic physicians have been part of broad medicine-pharmacy meetings convened by the National Association of Boards of Pharmacy, with Walgreens, CVS, the National Association of Chain Drug Stores, National Community Pharmacy Association, PhRMA, DEA and other groups to identify “red flags” that stakeholders agree would warrant some sort of further review.  It is anticipated that this set will be reviewed by the stakeholders in Spring 2015.

Red Flags of Illicit Use, Doctor Shopping, and Diversion of Controlled Substances

For Physicians

  • Symptoms incompatible with reported injury
  • History of problems with no medical records
  • Patient reports being from out of town
  • Multiple accidents
  • Insistence on drug of choice
  • Requests drugs by their street names, e.g. “blues” “Ms”
  • Loss of prescription or medications
  • Failure to provide or go for medical testing
  • Taking more medicine than directed
  • Requests medicine refills early
  • Use medicines from multiple physicians or filled at multiple pharmacies (as seen on the Prescription Monitoring Program)
  • Use of medicines prescribed for others
  • Use medicines in combination with alcohol
  • Paying in cash or sometimes uses insurance and other times cash

For Pharmacists

  • Prescriptions for large quantities of a “cocktail” or “holy trinity” of opioids, benzodiazepines, and carisoprodol
  • Diagnosis of lower lumbar pain. DEA testified that 90 percent of the pill mill doctors use lower lumbar pain as a diagnosis code
  • Pattern prescribing. Prescriptions for the same drugs, the same quantities, coming in from the same doctor
  • Shared addresses by customers presenting prescriptions on the same day
  • Customers going to the pharmacy counter with dilated pupils and difficulty concentrating
  • Unusual physical distance between the doctor, the patient, and the pharmacy
  • Patients paying in cash or sometimes uses insurance and other times cash
  • Prescriptions done in a “factory-like” manner – no reason to prescribe 15mg and 30 mg oxycodone because 30mg tablets are scored down the middle
  • Use medicines from multiple physicians or filled at multiple pharmacies (as seen on the Prescription Monitoring Program)
  • Inordinately large quantity of controlled substance prescribed
  • Prescriptions refilled at inconsistent intervals based on quantity
  • Use of street drug name by either the patient or the prescriber
  • Suspicion of forged or altered prescription
  • Suspicion of forged or altered identification or refusal to provide

What should you, the prescriber do?

If you or your patients have difficulties filling prescriptions for controlled substances at any pharmacy please contact the MMS Physician Practice Resource Center at (781)434-7702 or pprc@mms.org.

The President’s Podium: Reclassification of HCPs Reasonable

Posted in Drug Abuse, Health, opioids, Regulation on August 22nd, 2014 by MMS Communications – Comments Off on The President’s Podium: Reclassification of HCPs Reasonable

By Richard Pieters, M.D., President, Massachusetts Medical Society

The announcement today by the U.S. Drug Enforcement Administration that it is reclassifying hydrocodone combination products (HCPs) to a Schedule II drug – those substances with accepted medical uses deemed to have the highest potential for abuse and harm – is a reasonable step in the fight against prescription drug abuse – and long overdue.

The reclassification does raise important concerns for physicians and patients alike about access to appropriate treatment. Patients may have to make more visits to providers and pharmacists.  Physicians may have to write more prescriptions for shorter durations, and some physicians may prescribe alternative drugs that may be less beneficial or have adverse effects.

The Massachusetts Medical Society shares those concerns.  Physicians – always aware of the need to balance the alleviation of pain and the risks of addiction – recognize that patients who experience severe pain will always require treatment and should be able to get appropriate care and relief.

I have previously written about the challenges of prescription drug abuse, noting that the problem is severe, that addiction is a major public health problem that needs prevention and treatment, and that physicians must be part of the solution at the same time as the care and treatment of our patients remain paramount.

DEA has recognized the critical concern of physicians in issuing its new rule, by clearly stating that it “does not intend for legitimate patients to go without adequate care” and that “controlling HCPs as a schedule II controlled substance should not hinder legitimate access to the medicine.”

Further, DEA recognizes the role and responsibility of the physician in caring for his or her patient: “When a practitioner prescribes a medication that is a controlled substance for a patient,” it writes in its new ruling, “it must be because he/she has made a professional medical determination that it would be medically appropriate for the patient’s medical condition to treat with that specific controlled substance.”

The DEA’s reclassification of the most frequently prescribed opioid in the United States (nearly 137 million prescriptions for HCPs were dispensed in 2013), at the same time acknowledging physician concerns and professional judgment, is a sensible action in the face of a nationwide public health emergency of prescription drug abuse.

The complete DEA rule on the reclassification of HCPs is available here.

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