Yet Another Podcast on Drugs…

https://radio.foxnews.com/2018/05/02/yet-another-podcast-on-drugs/

Greg’s guest today is Jacob Sullum who is a senior editor at Reason magazine and a nationally syndicated columnist. They discuss new research that finds that the banned drug, MDMA (aka Ecstasy), helps PTSD. They also discuss some facts and fictions about the opioid epidemic.

 

https://radio.foxnews.com/2018/05/02/yet-another-podcast-on-drugs/

Podcast on the link…could not copy the link down to this post

Gov Kasich: wants to PLAY DOCTOR ?

Ohio sets new requirements for chronic pain patients to get opiates

— Ohio Gov. John Kasich on Wednesday announced new prescribing rules for patients suffering pain for more than six weeks, hoping that the move will prevent opiate addiction and accidental overdoses.

Prescribers will be required to:

* talk with patients and consider non-medication treatment

* assess the function of the patient,

* look for signs of abuse,

* consult with specialists,

* offer a naloxone prescription

* take other steps when treating someone suffering from subacute or chronic pain.

The more opiates a patient is taking, the more steps will be required by prescribers.

“Here is the message: if you have chronic pain, you don’t need to worry that somehow your medication will be cut off. The message is you’re going to be treated in a very special way, not that patients aren’t being treated that way now but it’s going to force everyone in that whole world to slow down and think about the individual,” Kasich said at a press conference.

The new rules, which take effect in the fall, won’t apply to hospice or terminal cancer patients.

Related: Five steps Ohio has taken to combat the opioid crisis

Some 80 percent of Ohioans who died from an overdose in 2016 had a history of abusing prescribed controlled substances.

While the Kasich administration efforts have led to a drop in deaths attributed to prescribed drugs, fatal overdoses on illicit drugs have continued to fuel Ohio’s alarming numbers.

“Don’t do street drugs, okay? That’s what’s driving up the numbers,” Kasich said.

Related: Drug overdose deaths jump 33-percent in Ohio

Accidental drug overdoses killed 4,050 Ohioans in 2016, up 33 percent over the 3,050 fatalities in 2015. Driving the spike is the emergence of fentanyl, carfentanil and cocaine laced with fentanyl, the health department reported.

The increase came even after the state spent $1-billion into programs to combat the crisis, including expanding Ohio Medicaid, distributing naloxone to counteract overdoses, beefing up the state’s online prescription tracking database and writing stringent prescribing rules.

Related: Ohio to start new limits on painkiller prescriptions

Related: Ohio Lt. Gov. Mary Taylor opens up about her sons’ opioid addiction

Unintentional fatal drug overdoses in Ohio have been on a steady, stunning climb from 904 in 2004 to 4,050 in 2016. Since 2007, unintentional drug overdoses have been the leading cause of injury death in Ohio — ahead of motor vehicle accidents. As Ohio puts more controls on prescribed opiates, people with addictions turn to illicit drugs such as heroin.

State Sen. Matt Dolan, R-Chagrin Falls, said he supports reducing addiction but “I do not think just legislating the practice of medicine achieves this goal.”

Kasich said the additional rules aren’t intended to interfere with the doctor-patient relationship. “You don’t want to ever put the government or silly rules in between a patient and the ability of the physician to be able to practice their great, great gift,” he said.

What Happened to the Untreated Chronic Pain Crisis?

https://www.painmedicinenews.com/Commentary/Article/03-18/What-Happened-to-the-Untreated-Chronic-Pain-Crisis-/47058

Simply stated, nothing has happened to the untreated chronic pain crisis. The same percentage of patients from the population still suffer from chronic, unrelenting pain. The only difference is this: We now know that one treatment option, when taken to the extreme, is not the simplistic solution that we had hoped for and were led to believe.

In retrospect, simplistic is a nice adjective along with delusional, foolish or academically corrupt to describe the belief that any human condition can be alleviated with a known addictive substance. How the pain management experts were able to dissociate from the accumulated knowledge of both medical experts and laypersons of the dangerous nature of opioids is beyond understanding.

During the 1920s, several laws were passed in the United States to deal with widespread addiction related to over-the-counter opioid availability. In the late 1960s, laws were once again passed to curb the overuse of various mind-altering drugs with the formation of a new drug enforcement agency. It appears that 50 years later, we made the same mistake again.

Addiction has been part of the human condition as long as recorded history. Addiction has even been used as a tool of war, for example, the use of opium by the British against the Chinese in the Opium Wars of the mid-1800s. There is growing consensus that the same percentage of the population has been addicted to some agents for at least several centuries. The overreliance on opioids for the treatment of chronic pain just substituted one psychoactive medication for others. It is interesting that as the opioid crisis has become more pronounced, there is less awareness of cocaine or methamphetamine addiction.

One new part of this equation is the development of a physician, pharmaceutical and insurance complex, with each achieving a different goal with opioid use but toward the same end. Now there is a massive rebound against the use of prescription opioids for chronic pain. In the process of righting the wrongs, a number of chronic pain patients who had regained function with the appropriate treatment of their disease state with opioids are now caught in the tidal wave and losing either their opioids or their function.

This loss of function has restored, in at least some of these patients, turning to street drugs, which have become ever more potent and dangerous. This is one unintended consequence of the appropriate reduction in the amount of prescription opioids written. All interested parties should now agree that the opioid genie is out of the bottle and can’t be eliminated from society. Well-intended prescribing guidelines and laws restricting the use of prescription opioids are inflicting real harm to patients everywhere.

The groups trying to alleviate this problem include lawmakers, who generally are poorly informed and trying to satisfy the needs of their constituents. There is a very loud constituency advocating for the reduction in addiction and overdose deaths. Lawmakers will attempt to pass laws that alleviate these problems, but inevitably, any law is so broadly written that it will cause harm to a patient whose chronic pain is being appropriately treated.

Pharmaceutical companies also have a very strong interest in the use of these opioid medications. Many new tamper-resistant opioids have been produced. Although many of these medications are more abuse deterrent, they are brand-name medications and generally poorly covered by insurance companies. The least expensive way to treat pain is with immediate-release opioids. These are also believed to be the most addictive medications. Because they can easily be either injected or vaporized and snorted, these medications have limited use in higher dosage forms. Insurance companies have also been reluctant to cover alternative treatments, such as physical and psychological therapies, for prolonged periods of time, which these patients need. Also, interventional techniques can help alleviate pain for at least a moderate amount of time.

One of the major problems with pain management, however, is that no technique has been shown to provide long-term pain control. Opioid medications; neuroadjunctive medications, such as gabapentin and dual-action antidepressants; traditional physical therapy, the above-mentioned procedures; and alternative treatments have not been proven to provide long-term pain control. The only techniques that have been shown to be helpful are some psychological techniques, such as cognitive-behavioral therapy. Therefore, it is difficult to advocate for any type of pain management treatment when, dependent on your point of view, nothing works. Further complicating the treatment of chronic pain are the comorbid conditions, such as psychological diagnoses, obesity, smoking, and social and societal problems.

This problem is in a state of great fluctuation. We’re at a point at which prescription drugs are being replaced by illegal drugs. This is further complicated by the fact that sophisticated pill presses can produce illegal pills that look like brand-name medications but can actually contain any number of psychoactive medications. The analogs of fentanyl are most dangerous; they can be up to 100,000 times as potent as opioids, milligram to milligram. The statistics are now likely to be corrupted because law enforcement members do not know what medications they are finding on overdosed patients, and only expensive toxicology reports can tell for sure.

The number of prescription medications actually peaked in 2012. However, the number of overdoses, overdose deaths and neonatal abstinence syndrome cases continues to grow. Emergency medical responders are actually becoming acquainted with addicts by name, as overdoses are becoming a recurrent emergency because of the prevalence of naloxone (Narcan, Adapt Pharma). Addicts can take themselves to the edge of death to achieve the most intense high, knowing that there is a good chance that they will be saved before they are not recoverable.

Because of the current fluctuation of the situation, the statistics that are being used are likely to be irrelevant to the current situation. One statistic that is assumed as fact is that more than a three-day prescription for pain medication will cause patients to become addicts. That is highly unlikely. A vast number of patients have been given post-op medications without becoming addicted. The treatment of chronic pain will require well-trained providers who are versed in a multidisciplinary approach, and a little bit of everything will be helpful.

DOJ/AG SESSION: another RAID on an addiction treatment center

DEA agents raid Watauga Recovery Centers in TN, VA, and NC

http://www.wjhl.com/local/dea-agents-raid-watauga-recovery-centers-in-tn-va-and-nc/1156361147

JOHNSON CITY, TN (WJHL) – Federal agents raided a Tri-Cities region addiction treatment organization Wednesday.

A spokesman with the Federal Drug Enforcement Administration said agents issued a Federal Search Warrant at the Watauga Recovery Centers clinic in Johnson City.

DEA Agent Jim Scott said search warrants were issued at multiple Watauga Recovery Center locations. News Channel 11 learned 9 clinics were searched Wednesday in Tennessee, Virginia, and North Carolina. The centers were closed after the raid but plan to re-open Thursday according to Dr. Tom Reach, clinic founder and president.

Watauga Recovery Center treats around 2500 patients.

Dr. Reach said they’ve done nothing wrong, and this raid sends the wrong message in the opioid crisis time that the country is in.

He said the agents also raised his home, they were looking for medical and financial records throughout the day.

“We have nothing to hide, we have never done anything remotely illegal, immoral, unethical, and we stand behind our practice. And we know we will be completely exonerated in this issue,” Dr. Reach said.

Agents were also looking for records of controlled substances, Dr. Reach said.

“Watauga Recovery Center has never had controlled substances in the facilities. We don’t sell, we don’t dispense,” Dr. Reach said.

Agents also confiscated cell phones and took hard drives from computers, which he said could keep them from seeing patients.

“My real concern is for the patients, if they’re unable to get care, the chances of them going back out and using street drugs, and using heroin and fentanyl, they could die from this,” Dr. Reach said.

No one from the practice was arrested or charged with a crime, Dr. Reach said.

We’re told the nine clinics that closed Wednesday will re-open Thursday.

AG SESSION/DOJ: now going after addiction clinics – not the addicts – follow the money trail ?

Five area doctors charged in pill mill case at addiction clinic

http://www.post-gazette.com/local/region/2018/05/03/Five-doctors-W-Pa-W-V-charged-narcotic-distribution-scheme/stories/201805030122

Five Pittsburgh-area doctors doled out Suboxone to addicts for cash at addiction clinics in Washington County and West Virginia where they worked as contract employees, according to federal investigators.

Indictments unsealed Thursday in U.S. District Court in Pittsburgh and in West Virginia named Krishan Aggarwal, 73, and his wife, Mudha Aggarwal, 68, of Moon; Cherian John, 65, of Coraopolis; Parth Bharill, 69, of Pittsburgh; and Michael Bummer, 38, of Sewickley.

All were connected with Redirections Treatment Advocates, a treatment center based in Washington, Pa., with locations in Bridgeville and the West Virginia cities of Morgantown, Moundsville and Weirton.

The investigation became public in January, when the FBI, U.S. Drug Enforcement Administration and the Department of Health and Human Services raided the clinics.

Christopher Handa, 47, director of operations, was later indicted on counts of conspiracy to distribute Suboxone, which is used to treat addicts, and submitting bills to Medicaid and Medicare for payments to cover the costs of the drugs.

Suboxone, a brand name, is a combination of buprenorphine, a relatively mild opioid, and naltrexone, which blocks other opioids from acting on the brain’s receptors. Experienced opioid users don’t experience a high from Suboxone, but it prevents them from going into withdrawal. So some users buy Suboxone to keep from going into withdrawal during periods in which they can’t find heroin. And some try to manage their own recoveries by purchasing Suboxone on the streets.

The doctors, who were under contract at Redirections, are charged with similar crimes at the facilities where they worked.

Dr. Krishan Aggarwal and Dr. John, for example, are accused of authorizing Mr. Handa and others to fax prescriptions for Suboxone for patients who had no medical need for it and then billing insurance for the costs.

In the case of Dr. Bharill, who worked at the Morgantown office, the grand jury said he provided pre-signed blank prescriptions to Mr. Handa, who then completed the dosage information without the doctor being in the office.

Dr. Bummer is accused of the same at the Washington office and Dr. Mudhu Aggarwal at the Bridgeville office.

Dr. Krishan Aggarwal, Dr. Bharill and Dr. John are all charged in the northern district of West Virginia because they worked at the clinics there; their cases will be heard in Clarksburg, W.Va. The other two are indicted in Pittsburgh because they worked at clinics in Washington County.

U.S. marshals hauled them all into federal court Thursday in handcuffs. U.S. Magistrate Judge Robert Mitchell released them on $50,000 bonds and let them return to work.

All had just been appointed lawyers or said they would retain their own lawyers. Mr. Handa’s lawyer, Ralph Karsh, has refused comment on the investigation.

Dr. Bummer’s lawyer, Efrem Grail, said his client and his family are “deeply concerned by the grand jury’s charges. We look forward to reviewing the evidence.”

The case is being brought as part of a Justice Department program called the Opioid Fraud and Abuse Detection Unit, announced last summer to track and prosecute health care professionals who illegally deal drugs and contribute to the nation’s opioid crisis.

Several other unrelated cases are also being prosecuted in this district under the initiative, which relies on data analysis and other tools to track doctors who over-prescribe.

U.S. Attorney General Jeff Sessions also assigned a dozen prosecutors in each of 12 “hot spot” districts around the country where the opioid crisis was most acute. Pittsburgh was one of them; the special prosecutor here is Assistant U.S. Attorney Robert Cessar.

The first case in the nation since the creation of the national unit was a local doctor, Andrzej Zielke, 62, of Hampton, who operated Medical Frontiers in the Richland Mall. He is under indictment here on charges of running a pill mill.

Federal agents, who had been investigating Dr. Zielke since 2014, said he was doling out prescriptions to addicts for cash, including at least one who died of an overdose.

The DEA estimates that eight of 10 heroin addicts in the U.S. started out as prescription painkiller abusers.

Mr. Cessar and his boss, U.S. Attorney Scott Brady, said the administration’s efforts are geared towards finding the “outliers” among doctors and other healthcare professionals who are fueling addiction for their own benefit.

“We want to attack this epidemic with all of the tools in our arsenal,” said Mr. Brady.

Study Finds Opioid Medication Effective for Chronic Pain

www.painnewsnetwork.org/stories/2018/5/3/study-finds-opioid-medication-effective-for-chronic-pain

Opioids have been used for thousands of years to provide relief from pain. But are they an effective treatment? Are they worth the risk of addiction? And do they improve quality of life?

Millions of chronic pain patients who use prescription opioids so that they can work, sleep, bathe and do simple household chores would quickly answer “Yes” to those questions.

But that’s a radical concept in an age of anti-opioid hysteria and propaganda. Prominent anti-opioid activists insist that “opioids are ineffective or can worsen both the pain and the long-term outcome.” And the CDC’s opioid prescribing guideline tells us there is “insufficient evidence to determine long-term benefits of opioid therapy for chronic pain.”  

Except now there’s a review that says opioids are effective and the evidence was there all along.

Researchers at Brown University and Tufts University School of Medicine analyzed 15 clinical studies performed for the Food and Drug Administration that looked at the effectiveness of opioids in treating chronic non-cancer pain. Their findings were just published in the Journal of Pain Research.

“The recent claims that opioids lack efficacy for chronic pain have created controversy among physicians, prescribers, regulators, scientists, and the general public,” wrote lead author Nathaniel Katz, MD, president of Analgesic Solutions and a professor of anesthesia at Tufts University.

bigstock-Chronic-Pain--Medical-Concept-89339426.jpg

“This review was, therefore, performed in order to gather together the key evidence to facilitate understanding opioid efficacy within the paradigm of FDA studies required for approval, and to perform a meta-analysis in order to quantify opioid efficacy for chronic pain.”

‘Ample Evidence’ Opioids Work

The authors are careful to note that they did not try to study or minimize the risks of opioids but were simply trying to reach “an accurate assessment of their benefits.” The 15 placebo controlled studies they reviewed evaluated the effectiveness of hydrocodone, oxycodone, tramadol and other opioids for up to 3 months.

What did they find?

“There is an ample evidence base supporting the efficacy of opioid analgesics for at least 3 months’ duration,” Katz wrote. “This evidence base is at least as large as that for any other class of analgesics, and analysis of responders demonstrates clinically meaningful improvements.”

Nearly two-thirds of the patients (63%) who participated in the 15 studies demonstrated “a clinically meaningful response” to opioids as a treatment for chronic pain. Their physical function only improved marginally, and researchers say there was no positive or negative effect on the patients’ mood. Interestingly, adverse effects were similar in the patients who took opioids and those who were given placebos.  

In short, the authors found no reason to abandon opioids as a treatment for chronic pain.

“While the effectiveness of existing treatments for chronic pain leaves plenty of room for improvement, and considering that only a small minority of patients do not experience clinically meaningful treatment response, discarding all analgesics approved for chronic pain contradicts numerous treatment guidelines, international treatment guidelines, widespread patients experience, and the FDA approval process,” they wrote.   

Critics will no doubt question why the authors only reviewed studies that lasted 3 months or less. The answer is that high quality, placebo controlled studies longer than that simply don’t exist. Long term safety and efficacy studies are not required for a drug to get FDA approval — which is why many anti-opioid activists and the CDC claim there is “no evidence” or “insufficient evidence” that opioids work long-term. It’s also a misleading statement, because non-opioid pain medications and alternative treatments are not studied for long periods either.   

“The reason for the 3 months isn’t because there aren’t good studies that go beyond 3 months but that 3 months is the period of time the FDA requires for efficacy studies.  It is the regulatory standard for assessing long-term efficacy of placebo-controlled studies in chronic pain conditions,” explains pain management expert Lynn Webster, MD, who is vice president of Scientific Affairs at PRA Health Sciences. 

Webster says there are technical and ethical reasons researchers do not conduct longer studies of analgesics.

“It is very difficult to conduct longer studies that are placebo controlled because of the number of dropouts in the placebo arm and the ethical concerns of denying patients access to treatment,” he told PNN. “It is true there aren’t placebo-controlled studies longer than 3 months but there are extended open label studies that are 12 months.  As the article states, these extension studies show the efficacy (of opioids) is maintained.”  

Katz and his colleagues have worked as consultants to Endo, Pfizer, Purdue Pharma and other opioid makers, which they disclose in their article. Funding for the study was provided by Analgesic Solutions and several pharmaceutical companies.

Hon. John P. Flannery “It’s Time To Protect Our Pain Patients and Doctors”

A tired Pharmacist is a Dangerous Pharmacist ?

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‘Worst drug epidemic in American history’: Durbin, Schneider discuss opioids with North Chicago pharmacy students

http://www.chicagotribune.com/suburbs/lake-county-news-sun/news/ct-lns-durbin-schneider-opioid-speech-st-0503-story.html

While pharmacists have the right to refuse to fill a prescription, a fear of being reprimanded or fired may be leading them to do it anyway, according to a student at Rosalind Franklin University’s College of Pharmacy.

The third-year pharmacy student was responding to a question posed by U.S. Sen. Dick Durbin Wednesday afternoon at the North Chicago school following some remarks by Durbin and U.S. Rep. Brad Schneider (D-Deerfield) about the opioid crisis.

“We’re in the midst of the worst drug epidemic in American history,” Durbin said. “Our opioid crisis, I have witnessed in every corner of our state. There’s no suburb too wealthy or town too small. It’s hit everywhere.”

Schneider told of his experience of receiving 120 Vicodin pills after complaining of pain from a kidney stone.

“Help me understand why I needed that kind of prescription,” he said. “As we talk to doctors, what I’m being told is they don’t they get the education in med school, they’re not getting the education in their residency and so we just need to make sure we’re providing the information as we learn more about addiction.”

Durbin asked the group of students and faculty, some practicing pharmacists, how a pharmacist would be trained to address a situation like that.

One pharmacist said they have the professional right to deny a prescription. She added she would advise her students to talk to the patient to better gauge the situation or call the doctor for more information.

“I wonder how often that happens, that a pharmacist says no,” Durbin said.

“Every day,” came one response.

Part of the problem is that pharmacists are evaluated on the number of prescriptions they fill, the third-year student said. Complaints from patients could also lead to reprimands.

“It’s really the struggle between obviously we know that we shouldn’t be filling this, but I need a job at the same time,” she said.

Some retailers are making changes to switch that incentive by not including opioid prescriptions in their quotas, another third-year student told Durbin.

It’s something all companies should start doing, he said.

“We have to get everybody on board,” Durbin said. “You can’t just look the other way at any level. Whether it’s the pharmaceutical companies, the distribution companies, the dispensers, the prescribers and the pharmacists.”

Durbin said he’s been working to get the Drug Enforcement Administration to lower the cap on the amount of opioids pharmaceutical companies are allowed to produce each year for domestic consumption.

Two years ago, the last reported period, the DEA approved the production of 14 billion pills, enough for every adult in the U.S. to have a three-week prescription, he said.

Durbin said he’s also introduced a bill that would allow the DEA to consider the risk of abuse and overdose when establishing the quotas.

More awareness training has to be done for various medical professionals to ensure they’re aware of the latest guidelines from the Centers for Disease Control and Prevention, he said, crediting professional associations that have made continuing education a requirement.

Another bill introduced by Durbin back in 2016 that he’s still pushing would require drug company representatives who promote opioids to be licensed and to undergo training.

He’s also suggested a tax on opioid medications that would fund take-back programs like the one in Lake County that allows people to turn in medications with no questions asked.

Schneider said he has also introduced legislation that would require three-hours of continuing education for doctors who prescribe opioids.

“There’s a lot for us to do,” Durbin said.

emcoleman@tribpub.com

Twitter @mekcoleman

“One pharmacist said they have the professional right to deny a prescription. She added she would advise her students to talk to the patient to better gauge the situation or call the doctor for more information.”

I find this statement very interesting… yes.. a pharmacist has the right to refuse to fill a prescription, but normally that involves a drug interaction with the pt’s existing medications and new medication, a allergy to a medication, dose is too high or TOO LOW or some other valid reason/fact that the new medication will harm the pt.

Apparently this woman is an instructor at the pharmacy school ( Rosalind Franklin University’s School of Pharmacy School ) where this Congressional meeting took place and I don’t know if it was intentional or unintentional.. but this instructor’s name was not mentioned in the article… Afraid to stand up for her beliefs ?  I just wonder how much her instructions to future pharmacists in her classes is more about “just saying no” to all pts with opiates and/or controlled substances.

Proposal would ease penalties under new Nevada opioid law

www.reviewjournal.com/news/politics-and-government/nevada/proposal-would-ease-penalties-under-new-nevada-opioid-law/

Tough proposed disciplinary regulations aimed at curtailing overprescription of opioid painkillers would be eased considerably under a recommendation approved Wednesday by a subcommittee of the Nevada State Board of Medical Examiners.

Instead of the strict rules contained in draft regulations made public after the Prescription Drug Abuse Prevention Act took effect on Jan. 1, the subcommittee will recommend that the consequences for violations of the law will be left to the board’s discretion, based on a prescriber’s “good faith attempts at compliance.”

The original draft created an uproar at a January workshop among doctors who said the law and regulations didn’t adequately define the types of conduct that could lead to penalties or even the loss of their medical licenses.

In response, the medical board created a committee of about 20 doctors, lawyers and health care leaders to look at possible amendments to the regulations, leading to the recommendation approved Wednesday.

The law, passed in the 2017 Legislative session, mandates added paperwork for doctors prescribing opioids. The original regulations said doctors could lose their licences after five violations, even if they were clerical, like forgetting to pull up a patient’s prescription history, and had no direct impact the patient’s safety.

Discipline not required

Both doctors and patients have said in the four months since its implementation, the law has prevented some doctors from prescribing opioids for patients at all, regardless of the legitimacy of their needs.

The proposed regulation adheres to the board’s existing disciplinary process for other laws governing prescribers and gives the medical board the option to abstain from disciplining a doctor if members deem it appropriate.

It also mandates that a doctor who violates the law perform continuing medical education coursework.

“I think what the Legislature tried to do was come up with a response to an obvious issue, but in doing so, they created another set of concerns and worries among the providers, and that was the fear they were going to somehow be held accountable for things beyond the control,” said Dr. Victor Muro, chairman of the subcommittee and a medical board member. “I think what the subcommittee tried to do was address the issues … because the reality of it is that one of the unintended consequences was the continuity of care was disrupted.”

 

In addition to the disciplinary regulation, the subcommittee plans to recommend to the Board of Pharmacy a regulation to simplify the informed consent and patient medication agreement forms required by the law. Doctors have expressed concerns that they’d have to create additional paperwork to switch a patient’s prescription from one opioid medication to another, but the regulation would create a blanket form for any opioid medication.

If the Board of Medical Examiners approves the recommended regulation at its June meeting, it will be discussed at a public workshop and a hearing before it heads to the state Legislative Commission for approval. Catherine O’Mara, a committee member and executive director of the Nevada State Medical Association, said she expects the regulation to be in place by early fall.

Still, the committee acknowledged at Wednesday’s meeting that while the regulation would clarify how doctors would be disciplined for violating the law, there would need to be changes to the legislation itself in the 2019 session, including clarification as to whether all controlled substance prescribing is regulated, or just prescribing painkillers.

“I think there’s a lot of things that have to be addressed probably in the next session,” Muro said. “I think what we’re trying to do here is try to provide a little guidance in the interim.”

Contact Jessie Bekker at jbekker@reviewjournal.com or 702-380-4563. Follow @jessiebekks on Twitter.

 

Requirements under the law

The Prescription Drug Abuse Prevention Act limits initial opioid prescriptions to two weeks and requires doctors to perform patient risk assessments before prescribing.

After one month of prescribing, doctors and patients must enter into written prescription agreements.

Three months in, doctors should have a diagnosis for the patient’s pain.

A doctor shouldn’t prescribe more than a one-year supply of a drug within 365 days, according to the law.