Opiates

[ventana]

got this in my email

 

comments????

 

 

 

 

Hi All,

New report from John Hopkins on the rx opioid epidemic and evidence-based approaches

Post article: https://www.washingtonpost.com/local/maryland-news/johns-hopkins-report-says-to-focus-on-opiod-prescribers-and-dispensers/2015/11/16/8953cc3a-8a55-11e5-be39-0034bb576eee_story.html?hpid=hp_local-news_mdheroin-130pm%3Ahomepage%2Fstory

Full report: http://www.jhsph.edu/research/centers-and-institutes/center-for-drug-safety-and-effectiveness/opioid-epidemic-town-hall-2015/2015-prescription-opioid-epidemic-report.pdf

Hopkins report says to focus on prescribers and dispensers

Stricter guidelines for prescribing and dispensing powerful pain medications are needed to curb the nation’s deadly opioid epidemic, according to a report released Monday from public-health leaders at Johns Hopkins University.

The analysis offered broad recommendations for addressing opioid abuse, but it stood out for its focus on the supply chain, including physicians and pharmacists.

It called for greater monitoring, training and rule-making to prevent misuse of opioids, addiction and overdoses, and said that doctors often prescribe pain medications “in quantities and for conditions that are excessive, and in may cases, beyond the evidence base.”

[In Maryland, 3 in 10 people have known someone addicted to opioids ]

The report called on states and the federal government to overhaul their rules for prescribing opioids, saying existing guidelines are “too permissive.” It applauded Washington state for passing a law that established new dosing criteria and guidance on when to recommend consultation for patients who may be addicted.

The report also said medical licensing boards should have greater authority to investigate high-risk prescribers and dispensers.

[Veterans drop hundreds of empty pill bottles in front of the White House ]

Other recommendations included: Mandatory use of patient surveys to track pain, mood and body functionality; urine drug screening; and collection of prescription data to identify patients who may need substance-abuse treatment.

Additionally, the report called for mandatory training in pain management and opioid prescribing for doctors and medical students, including residencies in pain medicine for medical-school graduates.

Andrea Gielen, director of the Johns Hopkins Center for Injury Research and Policy, said in a statement that the recommendations “cover the entire supply chain, from training doctors to working with pharmacies and the pharmaceuticals themselves, as well as reducing demand by mobilizing communities and treating people addicted to opioids.”

The report comes as a Maryland task force appointed by Gov. Larry Hogan ® is developing recommendations of its own to address opioid abuse.

Hogan, who lost a cousin to heroin addiction, has already allocated new money to treat addicts in county jails, and he has proposed increasing capacity at treatment clinics, boosting recovery housing and detoxification services, and disrupting gangs that distribute heroin, among other measures.

[Maryland launches initial plans to fight heroin epidemic ]

Opioid abuse has risen dramatically in recent years, in large part because of addiction to prescription pain pills and a growing use of heroin as a relatively cheap alternative that offers a similar high. Federal survey data from 2010 and 2011 found that 4 percent of ­Marylanders had used prescription pain relievers for ­nonmedical purposes within the previous year.

The nationwide rate of heroin deaths has nearly quadrupled since 2000, according to the Centers for Disease Control and Prevention. In Maryland alone, 578 people died of heroin overdoses last year, representing a 25 percent increase over 2013 and more than twice the number in 2010.

A recent Washington Post-University of Maryland poll found that nearly 3 in 10 Marylanders say they have a close friend or family member who was or is addicted to opioids such as heroin and prescription pain pills.

The Johns Hopkins report came from the university’s Bloomberg School of Public Health, with input from professionals in the medical, pharmacy, injury-prevention and legal fields.

 

 

[winterallsummer]

It's a real problem. When I was in school I was taught to hand out ultram, flexeril and T3 because "that's why people come to the doctors for otherwise they wouldn't need to see us." There is decent literature out there showing that opiates are not improving outcomes short or long term for many of the causes they are prescribed for such as MSK pain. I have been saying for a while we need to focus on what really helps with chronic pain: diet, exercise, involvement in the community for support, PT, managing expectations, support groups, ergo dynamics, better sleep hygiene, et cetera. When patients need medication beyond OTC remedies we need to reinforce this to them. There also is a lot of room for non opiate Rxs such as SNRIs, neuroleptics, low dose TCAs to name a few.

 

We also live in a society where people expect to live pain free. That's not how it works. I tell my patients about a doctor I used to work with who had three back operations after a MVA and had 8/10 pain on a good day yet still came to work day after day on his feet. That's life.

 

Patients want the magic pill and as providers it is often easier to write for something a patient is often already on or got before in the ER than have this conversation with them. Many won't listen to us and will just shop for another PA or Doctor. Others are even demanding and manipulative or outright abusive. However others will appreciate you take the time to explain this to them.

 

I blame part of this epidemic on the pain as the fifth vital sign which is often the biggest load of crap ever. Yes pain in acute conditions that require hospitalization or surgery is sometimes over treated. But I refuse to believe I'm a bad provider for not getting my patients high because "that's their medical right in America" as one patient once put it. A lot of damage has been done and fixing the mind set of provides and patients will take years. I am all for bettering education however no surprise that the "answer" is going to be closer monitoring. I am very conservative so not really worried however not excited whatsoever about increased regulations and the paperwork that will follow.

[winterallsummer]

Acute conditions sometimes under treated* is what I meant to say in above post.