Pa. boards of pharmacy and medicine approve new opioid prescribing guidelines
Does it seem strange to anyone but me.. that the PA Board of Pharmacy is getting involved with prescribing guidelines when the profession that they oversee.. DOES NOT HAVE PRESCRIPTIVE AUTHORITY
I find it interesting that while most Medical Licensing Board would sanction a prescriber for prescribing medication for a pt that they had not done a in-person physical exam of the pt, but these same bureaucrats sees it within their scope of authority to place limits on the amount of opiates that a prescriber can give a pt. Another example of those that who are placed in authority would do things – write regulations concerning – that they could not do as a practicing physician without the risk of being sanctioned by the Medical Licensing Board. Unless one or more prescribers hire a law firm to challenge the legality of this regulation.. it will remain “on the books” and be enforced.
The state boards that oversee licensing and discipline for doctors and pharmacists agreed Tuesday to adopt new guidelines for distributing and prescribing opioids.
While the Board of Pharmacy’s vote came quickly in open session, the Board of Medicine’s vote to approve two sets of opioid prescribing guidelines came after a closed-door executive session of an hour and 10 minutes. The medical board approved guidelines dealing with emergency room care and the use of the painkillers to address non-cancer pain and agreed to address additional guidelines at a meeting next month.
Physician General Rachel Levine told both boards that an overemphasis on pain reduction, the development of powerful opioids and the influx of cheap heroin have “exploded into the overdose crisis that we’re seeing today.”
A record 3,383 Pennsylvanians died of overdoses in 2015, and Dr. Levine said the numbers in the first quarter of this year suggest an even grimmer toll for 2016. Nationally, the annual number of overdose deaths is approaching the American death toll from the entire 12-year Vietnam War, she said.
The Board of Pharmacy, which licenses and regulates pharmacists, quickly and unanimously approved new guidelines for dispensing opioids. The Board of Medicine listened to and questioned Dr. Levine for an hour before meeting in executive session.
“Properly prescribed opioids have a wonderful place in medicine,” said Keith E. Loiselle, the public’s representative on the Board of Medicine. He feared that “physicians become so fearful of making a mistake in this that they begin to underprescribe or perhaps not appropriately prescribe. … Not every patient becomes a heroin addict.”
“No one is saying that all opioids are bad,” Dr. Levine answered. “But the pendulum has swung way too far” towards overprescribing.
At an afternoon press conference, Gov. Tom Wolf said he was proud of his administration’s work in creating the guidelines.
“The goal for all of us is to reduce the pattern of over-prescription,” he said.
Dr. Levine said the guidelines were developed by the Safe and Effective Prescribing Practice Task Force, a group of physicians, nurses, state agency leaders and community advocates. She said the guidelines encourage the “judicious” prescribing of opioid pain medications as well as other clinical efforts before opioids are used.
“Really, opioids should be one of the last treatments for acute pain or chronic pain, as opposed to the first treatment that’s prescribed,” Dr. Levine said.
In addition to the state board of medicine’s affirmation earlier Tuesday of the guidelines for chronic non-cancer pain and emergency departments, the board will hold a special session in August to review the guidelines for geriatrics, obstetrics and gynecology and treatment of opioid use disorder in pregnant women, Dr. Levine said.
The guidelines are voluntary, Mr. Wolf said.
“The emphasis on the guidelines is not so much for policing, it is much more to emphasize the treatment of this disease as we treat other diseases,” said Secretary of Health Dr. Karen Murphy.
Some examples of the advice in the guidelines:
• Patients with chronic pain not associated with cancer, if prescribed opioids, can be ordered to undergo periodic urine or saliva screenings and pill counts, in an effort to ensure that they aren’t taking extra drugs, or selling their medicine.
• Opioids shouldn’t be mixed with benzodiazepines, which are a class of sedatives.
• Prescriptions for opioids written in emergency departments should generally not be for more than seven days worth of pills.
• Pharmacists should be on the lookout for patients who may be getting opioid prescriptions from multiple doctors, or even forging prescriptions.
• Opioids should not be a first choice for pregnant or nursing women,because the mother’s chronic use of the painkillers can lead to neonatal abstinence syndrome, feeding difficulties, seizures and other symptoms in the child.
• Doctors should do a careful risk analysis before prescribing opioids to patients with psychiatric disorders.
• Elderly patients seem to be at increased risk of falling in the early weeks of opioid use, and should be especially warned against taking the painkillers with alcohol.
Pennsylvania lags behind some other states in approving guidelines. And even if its boards adopt the recommendations offered by Dr. Levine, Pennsylvania’s crackdown won’t match that of Kentucky, where the crossing of the 1,000-fatal-overdoses-per-year mark spurred a vigorous response.
Kentucky’s legislature passed into law in 2012 requirements that physicians conduct complete examinations and drug history checks of patients, and write up treatment plans, before opioids are prescribed. The law also required that doctors there recheck the prescription database every time opioids are recommended.
The Wolf administration in the last two months swung behind proposals to require that all prescribers take regular refresher courses in the proper prescribing of opioids, and that they check an emerging patient drug history database every time they recommend controlled substances.
The Pittsburgh Post-Gazette in May reported the results of a six-month investigation showing that, from 2011 through 2015, in Pennsylvania, Ohio, West Virginia, Maryland, Virginia, Kentucky and Tennessee, 608 doctors were disciplined by state medical boards for overprescribing narcotics.
Of the seven states, Pennsylvania was the least likely to discipline a given doctor for prescribing too many narcotics. States that vigorously policed physicians — often using narcotics guidelines and prescription databases — tended to see steeper declines in opioid consumption, the investigation found. Only Kentucky saw overdoses decline.
Dr. Levine said the state has responded to the overdoses with a six-pronged effort, including the guideline push. The other prongs:
• The administration is working with medical schools to teach students about addiction.
• Free refresher courses in opioid prescribing are now available to doctors and pharmacists.
• The database of patient prescription history will be available to doctors at the end of August, allowing them to ferret out drug-seeking patients and refer them to treatment.
• Treatment for addiction will be enhanced through $20 million in new grants to 20 centers of excellence statewide.
• Wide distribution of the drug naloxone has reversed at least 1,088 overdoses that could have been fatal.
Karen Langley contributed to this report.
Filed under: General Problems
I always ask the question , “Why?” Intent is everything and the superficial rhetoric is meaningless. Given that the CSA 1970 de juris created a leviathan bureaucracy, the DEA. Given that this most malignant tentacle of the State’s enforcement apparatchik is too important a ham handed fist of power maintaining control over the mundanes…that’s the body formerly known as “We the People”, they cannot and will not pass quietly in the night given the huge paradigm shift that is occurring. “What shift is that?”, you say. Well, the primary cash cow, the primary focus of the DEA’s role in the War on Drugs has always been the various species of Cannabis. The raison d’être for the CSA 1970 was to be used as a hammer to silence the most vocal critics of the Nixon Administration, the left leaning citizen activists/counterculture, a great number of them Jewish and their grass roots allies and the other vocal group, the urban black American and their organized, very vocal groups that were dissenters of much of that administration’s policies. They were protected by the First Amendment and Nixon had no way of silencing them. The one thing in common that most of these dissenters had was an open use of Cannabis. So, like virtually all other prohibitionist drug laws of the 20th century, the CSA 1970 has a huge racial bias at its base. Such was confirmed in a “deathbed confession by former Nixon adviser. Bob Haldeman.
The CSA 1970 proved to be the very vehicle for the watering down of the Bill of Rights guarantees, e.g., civil asset seizure, mandatory, road side drug testing as part of DUI interdiction, search of vehicles based on the signaling of a “trained” drug sniffing dog, the States being forced to engage in the policies and procedures set forth in the act and enforced by the DEA, who incidentally created more fiat law by periodically reinterpreting the laws with contradictory policies as the need and whim suited. crack cocaine laws that more or less singled out the black community for even greater punishment, enhanced and more or less warrant-less wiretapping of private communication, no-knock warrants, etc. The 4th, 5th, 8th and 10th Amendments were horribly eroded by the resulting laws and policies that the SCOTUS approved as tools to facilitate the “winning” of the War on Drugs. These erosions further were like the set in volleyball for further erosion, as the spike, by the War on Terror post 9-11.
So, as the states have decided to stop playing along with the ridiculous disinformation campaigns regarding Cannabis and to grow a backbone by allowing for its citizens to utilize the plant for medicinal and now even recreational use, the Beltway Bunch has seen the handwriting on the wall. The hoi polloi are going to use cannabis as they see fit, individually, no matter what the “official” stance is on it. At least the people who presume to rule over us understand from lessons learned with alcohol prohibition that resistance is futile, the State will be discounted..at least where Cannabis is concerned. So what to do with this uncouth, unruly brute squad, the DEA. The very substance that created all the work for them…the very substance who’s unlawful existence gave a veneer of legitimacy to the prevaricative practice of State sanctioned robbery at gun point, aka the Civil Asset Seizure Laws, is about to undergo a transformation into a quasi legitimate substance. All the time and money that were involved in this particular version of the Whack-a-Mole game is going away and there needs to be something done to keep the DEA funded, justify its existence and maintain the fiction that its all about Public Safety.
Now we have the war on opioids. Chronic painers, too bad for you. It’s time to lean how to roll a fatty, how to tell Carolina Sour Diesel from Humboldt Golden Kush or what vaping is. The other choice is to be lumped in with the poor souls who have an actual disease called addiction, as all are now afflicted with Opiate use Disorder. So pack your bag and get your affairs in order for at least the next 30 days, ’cause it’s either toke up or off to rehab for you…unless you can’t pay on your own, then you’ll get a 96 hour detox followed by and Intensive Outpatient Treatment Program with Suboxone for everyone. Opioids for Cannabis. The State giveth and the State taketh away…blessed be the name of the State…not.
It is prohibition all over again,,,created by a psychiatrist who has absolutely no uneducated about medical issues,,mary
Stunning.
The tsunami of lies and
Opiophobia continues
Notice they say pregnant women should not get opioids.
Should they get
Gabapentin?
Ibuprofen?
Tylenol?
What?
Got a email for this Dr.Levine??mary