Some of the key recommendations for medical providers include:
- Give alternatives to opioids before prescribing them; start with something less potent first, particularly for acute pain.
- Screen for risk of abuse or addiction before initiating prescription opioids
- Use methadone rarely, if ever, to treat acute pain. Also, it should only be prescribed by those who know the risks and are prepared to carefully monitor patients who take it.
See article: http://www.deseretnews.com/article/705293368/New-rules-aim-to-stem-overdoses.html?pg=1
We have been conducting 12 different focus groups with community members. In each focus group members consistently said doctors (dentists and medical doctors) were contributing to the prescription drug abuse problems in Utah County by making these drugs easy to obtain and prescribing too many at one time.
Question for Coalition Memebers
- How can we utilize these guidelines to help reduce deaths in Utah County?
- How can we utilize the guidelines to educate the medical community?
- How can we utilize the guidelines to educate the public?
- Ofter any other general feelings about how these guidelines will curb overdose deaths.
NOTE: I (Kye) recently met with our partners in the North IHC Council, chaired by Mayor Heber Thompson. One of the IHC employees said he would give representatives of our coalition time on their monthly staff meeting - about 100 Utah County physicians come to those meetings.
6 comments:
Hey, S.M.A.R.T.'ies, just read the e-mail Kye sent w/ news articles. In one article is listed a fella by the name of Dr. Kim Bateman who works for HealthInsight (one word). The group is a non-profit Medicare Quality Improvement Organization for Utah and Nevada. It is HQ'ed in SLC. I spoke with him Mon, March 30th. He states his research shows that approx half of deaths from narcotics in the states of Utah and Nevada are in people having valid prescriptions for narcotics. A disproportionate number of those deaths involve long acting narcotics or methadone. He is having a difficult time getting groups of doctors to attend HealthInsights presentation on narcotic prescription education. Perhaps we could partner with him in this effort. Dr Bateman is giving a presentation at BYU Student Health Center on May 20th @ 8 am. My boss, Rulon Barlow, has agreed to allow me to invite a handful of our coalition members to this presentation. It might be a good idea to see his presentation. What do ya think?
I have strong opinions concerning this issue and I absolutely agree we need to be speaking with physicians by any means available. Please allow me to expound. After reading Kye's emailed articles I found a few disturbing points of interest. Most notably, a suggestion was made that imposing "restrictions" will cause those who suffer from chronic pain to avoid medical help and seek a drug dealer for relief, thus transforming an otherwise law abiding citizen in a "junkie". Also I found some physicians support the restrictions while others do not. As I have performed my patrol duties I have found persons who use daily prescriptions are prone to doctor shopping, overuse and overdose, and most commonly driving under the influence. Most daily users take tablets from two or more separate drug categories( i.e. a narcotic for pain and a depressant for depression or anxiety). Studies have shown sum 40% of drivers arrested for DUI use two or more subsanbaces other than alcohol. Poly drug use in relation to prescriptions has risen in popularity as the same prescriptions have become more prevalent in society. These articles seem to pose a debate as whether there is a problem. As we know there is no debate, there is a problem. My concern then lies with any misperceptions or ignorance on the part of prescribing physicians. The article suggests these restrictions will cause a physician to become an agent of law enforcement and will force an otherwise law abiding person to break the law to get prescriptions. Where this statement suggest there is an inherent problem my point stems from the addictive nature of most prescriptions and how continued use leads to addiction and criminal activity. As tolerance to the substance rises so does the criminal acts related to use and possession. No one who uses an addictive substance is immune to addiction. The key then is prevention. I feel physicians will adhere to the standards if they are educated as to the reason for the standards. Here were are simply trying to convince physicians to be responsible in prescribing practices. Responsibility in reporting criminal activity is a topic for later debate.
D. Bing, I have heard some physicians say it is against HIPPA to report certain drug use behaviors by their clients - thus physicians do not contact law enforcement about prescription drug abuse and Doctor Shopping. Is this true? Does HIPPA limit Dr's ability to work with law enforcement?
Kye,
Hippa restrictions do not limit cooperation with law enforcment in criminal investigations or reporting what are obvious violations of the law. Hippa is ment to protect medical privacy but does not create a safe zone for criminal behavior. I am not aware of any provisions allowing a person to seek action againts a physician who reports what he believes is a crime being commuted. I have found sevral doctors are unaware of what is concidered criminal and simply fail to act out of ignorance. Still others are aware of the crime but are compled to continue service out of a sense of duty. Doctors want to help and that is where they are taken advantage off.
In reading the proposed guidelines I have to say as a nurse that I think that the medical community does have a responsibility to be giving out prescriptions with more accountability. Although they do not have control on how someone uses the medication, they can control how often, how much, and to whom they give them to. It is too easy in a busy world to just write out a prescription. I am not blaming all physicians for being careless, but I do see this at times. At times a pregnant woman gets narcotics during her pregnancy for her "aches and pains". I think in our hectic, stressful lifestyle they can become an easy tool to feel better from daily pressures because they DO make you feel good. The problem is that with too much use you may continue to need them to feel normal, and the pattern is set up to need more and more. There is also a misconception that "my doctor would never prescribe me anything that would hurt me" so using more and more prescription pills can be seen as not a problem-especially if a busy physician is willing to just "call in another prescription" without really looking at records. Perhaps he needs to say no? Anyone needing and asking for frequent pills needs further evaluation and referrel to pain clinics-even if the need is legitimate. Many of these addictions start out innocently but when they become real it is already too late. I do not see these restrictions as too strict-not with the scope of the problem--and yes-those who will use them anyway will still find a way to get them--legal or illegal. Any irresponsible drug use always has it's excuse. These restrictions are simply asking the public and the medical community to be accountable and to think!
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