Kentucky Doc Spring 2016 - Page 6

6 doc • Spring 2016 Kentucky Recent Federal Guideline And Marketing Changes In Opioid Prescription Policy By Robert P. Granacher, Jr., MD, MBA Larochelle et al. (2016) published research on 2,848 commercially insured patients, with ages between 18 and 64 years, who sustained a nonfatal opioid overdose during long-term opioid therapy for non-cancer pain between May 2000 and December 2012. Patients were followed over a median time interval of 299 days. Physicians re-dispensed opioids to 91% of patients after they had made a potentially fatal overdose. Two hundred and twelve patients had a second or third opioid overdose after being prescribed more opioids. After two years follow-up, the repeated overdose rate was 17% for patients receiving high doses of opioids after the index overdose. One just can’t make this stuff up. Unbelievably, almost all patients continued to obtain prescription opioids from their clinicians after they had made a potentially fatal overdose. This article further noted that research demonstrates that after an overdose, opioid discontinuation reduces risk for repeated overdoses. With regard to Kentucky, in 2013, there were 1,019 resident drug overdose deaths. This was a slight decrease from the prior high point in 2012. This placed Kentucky second among all states in our country for resident age-adjusted drug overdose death due to opioids (23.7/100,000). Of the more than 1,000 opioid overdose deaths, pharmaceutical opioids remained the primary cause of death, according to medical examiners. In 2013, pharmaceutical opioids were causally involved in 438 drug overdose deaths in Kentucky. Kentucky overdose deaths now exceed motor vehicle crashes as a cause of death from unnatural factors. In the 2011 to 2013 interval, the following Kentucky counties experienced the highest number of overdose deaths involving pharmaceutical opioids per 100,000 county residents: Bell, Clay, Floyd, Johnson, and Knox (Slavova et al. 2015). Within the last two months, two federal agencies have stepped up changes in guidelines for both treatment and marketing of opioids for chronic pain. In March 2016, the CDC published guidelines for prescribing opioids for chronic pain in the United States (C.D.C. 2016) These guidelines are CDC recommendations for prescribing opioids for chronic pain outside of active cancer, palliative, and end-of-life care. The following 12 guideline points are a summary of the entire CDC recommendations: 1. Non-pharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. 2. Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how therapy will be discontinued if benefits do not outweigh the risk. 3. Before starting, and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy. 4. When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended release, long-acting opioids. 5. When opioids are started, clinicians should prescribe the lowest effective dose. 6. Long-term opioid use often begins with ARE YOU DISABLED? HAVE YOU APPLIED FOR SOCIAL SECURITY DISABILITY? ARE YOU CAUGHT UP IN RED TAPE? An experienced Social Security Claims Advocate can help you: • By assisting you in filing your initial application. • Filling out and filing your appeals. • Gather medical and other important information to submit to Social Security. • C