scribe those high doses , a ) they ’ re dangerous , so b ) you need to document the need for it . And if you can reduce your high-dose patients to lower-dose patients , you should do that . Also , the new regulations limit the first prescribing of opioids for acute pain to seven days or less .”
In addition , Regulation 2.4 requires one hour of CME on prescribing narcotics each year as part of the already required 20 hours ( not in addition to ). Read the rule in its entirety at armedicalboard . org .
Mandated Emergency Room Guidelines
Arkansas , working with the ADH and other organizations , created Emergency Room prescribing guidelines to help reduce prescribing of opioid pain medications in hospital emergency departments . In 2015 , the Society drafted legislation requiring hospitals in Arkansas to adopt these or similar guidelines .**
Currently , the AMS is not aware of how well these guidelines are being adhered to . We hope to follow up on this in a future issue .
Naloxone
Nearly all 50 states have enacted improved naloxone access laws – another recommendation by the Task Force and supported by the Arkansas Office of the State Drug Director . According to the Task Force ’ s 2018 Progress Report , “ Between January 2018 and April 2018 , naloxone prescriptions dispensed reached a record high in the United States , increasing to more than 11,600 naloxone prescriptions .”
This was made easier by legislation supported by Arkansas physicians ( Act 284 of 2017 ) that makes it easier for physicians and pharmacists to dispense naloxone to patients or caregivers without a prescription .
“ The Office of State Drug Director is trying to equip all the first responders with Naloxone , which short-term reduces opioid overdose . And certainly , these doctors who are prescribing these high doses of medicine need to ask their patients to get naloxone , which they can get even without a prescription or their doctors can write the prescription . This is so they can have it , not for self-administration , but in case they need to administer it in their home ,” said Dr . Smith .
Michael Mancino , MD
The Addiction Treatment Front
A former Arkansas representative and an AMS past president , Gene Shelby , MD , is an expert on opioids and opioid addiction treatment . With his wife Faridah Katkhordeh , he runs a Suboxone ® - assisted ( buprenorphine ) opioid treatment facility in Hot Springs and represents Arkansas and AMS as a member of the AMA Task Force . Dr . Shelby has seen his treatments save lives and has also seen them misunderstood by others who are on the same side of the fight . In the August 2016 issue of The Journal , Dr . Shelby and one of his patients described in detail the workings of his treatment methods . He also shared his hope that physicians will endeavor to understand the risks opioids pose to some patients , learn all they can about outpatient treatments for dependence , and consider treating patients as he has . “ Doctors need to know about this treatment ,” he stressed . “ They may well encounter a patient that is taking Suboxone ® , and they ’ ll need to know a little bit about how it works and its interactions .”
Dr . Shelby has not seen evidence of increased treatment options with buprenorphine for people with opiate dependence in Arkansas . He shared news of an editorial in July 5 , 2018 , the New England Journal of Medicine that urges primary care practices to offer buprenorphine treatment . As for the state ’ s response , Dr . Shelby said , “ Arkansas rejected this model and instead is focusing on centering treatment on regional mental health centers . Unfortunately , many of these don ’ t have physicians who prescribe buprenorphine . And these centers don ’ t coordinate well with primary care practices . Also , many in our state government believe the myth that buprenorphine treatment is simply replacing one drug for another and not a real treatment for addiction .”
Dr . Shelby doesn ’ t agree with the idea he described as “ myth ” and instead adopts the view of the aforementioned New England Journal article , which states , “ If relying on a daily medication to maintain health were addiction , then most patients with chronic conditions such as diabetes or asthma would be considered addicted .” He shared an audio interview with more information .***
Help for Physicians Providing Medication-Assisted Treatment
There is some help for primary care practices who decide to provide medication-assisted treatment , or MAT . Under the leadership of Michael Mancino , MD , the UAMS Center for Addiction Services and Treatment provides evidence-based medication-assisted treatment to Arkansans with Opioid Use Disorders ( OUD ) in the form of methadone , Suboxone ® , or naltrexone .
In addition , to help rural doctors with their MAT questions , UAMS has partnered with the DHS to provide a free one-on-one consultation service for health care providers treating patients with OUD . The project , known as MATRIARC ( Medication-Assisted Treatment Recovery Initiative for Arkansas Rural Communities ), provides a hotline that providers can call for advice on related topics ranging from the provision of medication-assisted treatment to insurance issues . An addiction expert is also available for telemedicine consultations . For information , call 501-526-8459 ( toll-free 1-833-872-7404 ).
“ These are resources for physicians in rural areas to assist with complicated cases of patients with chronic pain and how to have the difficult discussion around the potential that there may be an opiate addiction in the patient ,” said Dr . Mancino . “ Getting trained to provide medicationassisted treatment for opioid use disorder with buprenorphine will allow physicians to have an option to continue to provide care for a patient that is in their practice that they identify as having an opioid-use disorder . With support from the Division of Behavioral Health Services ( DHS ), they will have several resources to assist them in providing this life-saving medication treatment and not feel that they are doing this all alone .”
AR-Impact
CME is also being provided through UAMS ’ s new interactive training service known as AR-IM- PACT ( Improving Multi-Disciplinary Pain Care Treatment ), a weekly interactive tele-video consultation service designed to help clinicians better manage their chronic pain patients by seeking to look at multiple ways to improve pain treatment and avoid opioids if possible . This free resource features seminars on different topics delivered via tele-video conference and therefore accessible to providers around the state . It takes place each Wednesday from 12 to 1 p . m .; however , there is a website with instructions and most seminars are also available online to allow users to complete them on their own time .
Each program starts with a brief presentation about an aspect of care of these patients fol-
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