by CASEY L . PENN
Opioid Reduction Efforts : An Ongoing Battle
Physicians Among Those at Work on the Crisis Here in Arkansas
We could have named this article , “ Opioids : The Epidemic of the Century .”
Sadly , it has become that . According to the Centers for Disease Control & Prevention , more than 100 Americans die each day from an overdose of opioid drugs . Prescription medications account for 40 % of those deaths . In its prescribing rate for opioids , Arkansas is the second highest in the nation .
By mere association as prescribers , physicians may shoulder more blame than they deserve . This per AMS Executive Vice President David Wroten , who noted that , in truth , the majority of opioid overdoses result from non-prescribed opioids rather than prescription drugs . “ The blame game makes for great headlines ,” stressed Wroten , in a recent Democrat-Gazette article . “ The truth is there is more than enough blame to go around .
“ Physicians , like everyone else , were caught off guard at the magnitude of the opioid abuse epidemic . However , long before there were headlines , Arkansas physicians began working to address this crisis in our home state . Rather than attacking doctors , let ’ s look at what doctors have done right .”
Indeed , since opioids became a national crisis , the AMS and many member physicians have collaborated with legislators , the Arkansas Department of Health , state drug officials , and other stakeholder groups to reduce opioid use and to reduce associated deaths – with some success . From 2013 to 2017 , the number of opioid prescriptions written by physicians and other prescribers decreased by more than 55 million
– a 22 % decrease nationally according to IQVIA , a national data research company .
Over the next few months , The Journal will bring you more on this topic . We hope to deliver in-depth pieces on cutting-edge research , medication development , educational opportunities , and other efforts being conducted right here at home to confront this epidemic . For now , we hope this brief update increases your knowledge of resources to draw from as you encounter the effects of opioids in your patient populations .
Many of the efforts that are underway in Arkansas sprang from the state ’ s participation in the American Medical Association Opioid Task Force . The Task Force formed in 2014 and works to identify and implement best practices in combatting opioid abuse . Members include 18 national medical associations and eight state medical associations . Although there is work yet to be done , some recommendations from the Task Force are being realized . These include registration and use of prescription drug monitoring programs ; greater access to Naloxone , the antidote used to prevent immediate death from overdosing ; comprehensive care for patients in pain and with substance use disorders ; and targeted education on opioid prescribing . ( Find the AMA Opioid Task Force 2018 Progress Report at end-opioid-epidemic . org .)
Prescription Drug Monitoring
Physicians helped pass legislation in 2011 that established the state ’ s use of the national Prescription Drug Monitoring Program , or PDMP . The PDMP is a database that records what controlled substances are prescribed and dispensed to patients . By accessing it , physicians and other clinicians can see what medications their patients are taking ( and where those were prescribed ). Such information is helping physicians avoid drug interaction issues and preventing patients from “ doctor shopping ” for narcotics .
According to the Task Force , participation in the PDMP is growing rapidly – from 471 , 896 nationally in 2014 to more than 1.5 million in 2017 . In Arkansas , physicians and other health care professionals in Arkansas increased use of the state PDMP by 61 % in 2017 .
Of course , some participation has become mandatory . Act 820 of 2017 requires physicians ( or their designated delegates ) to check the PDMP every time they write a prescription for a Schedule II or III opioid and every first time they prescribe a benzodiazepine . ( Exemptions include PDMP inoperability and prescriptions written for patients under palliative care , hospice care , nursing home residency , and cancer care in some instances .) This legislation also directs state licensing boards to adopt rules limiting Schedule II dosage amounts ( keep reading for more on this ).
Also of note , the PDMP group at the ADH has started a controlled substance “ report card ” that goes out quarterly ( via email ) to all prescribers of opioids – physicians , APRNs , PAs – showing them how they compare to their peers . UAMS Professor of Psychiatry , Medicine and Public Health G . Richard Smith , MD , explained how it works :
“ I think everybody that prescribes opioids ought to look at their report ,” said Dr . Smith , who is also the medical director of the ADH Drug Mis-
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