by STUART HAYMAN, M.S.
As I write this column, we are in the middle of what has already become one of the worst flu seasons in more than a decade. The number of flu-related hospitalizations and deaths has been front-page news for weeks, and will likely continue to grip our attention as we head toward spring.
As we collectively turn our attention to the havoc wrought by a particularly deadly flu season, however, it’s easy to forget about the other public health emergency that so many Americans are facing every day: the opioid epidemic.
The rate of opioid overdose deaths has increased 200 percent since 2000. From 2000 to 2016, more than 600,000 people died from drug overdoses. According to the U.S. Centers for Disease Control and Prevention (CDC), opioids were involved in 42,249 deaths in 2016 alone. Today it is estimated that more than 2 million Americans abuse opioids.
New York has not been spared from the opioid epidemic. In fact, the CDC identified New York as one of the states that experienced a statistically significant increase in drug overdose deaths from 2015 to 2016.
In 2012 Gov. Andrew Cuomo signed legislation aimed at overhauling the way prescription drugs were distributed and tracked in the state. At the time, New York state Sen. Kemp Hannon noted the alarming fact that in the previous documented year, 22 million new prescriptions for painkilling drugs (not including refills) had been written in a state that is home to 19.5 million people.
The legislation signed in 2012 created a new, updated prescription monitoring program (I-STOP) that made it harder for patients to “doctor shop” to illegally obtain prescriptions from multiple practitioners. Through the Prescription Monitoring Program (PMP) Registry, information about dispensed controlled substances is reported by pharmacies in “real time,” and both practitioners and pharmacists can view a patient’s controlled substance history. As of
August 27, 2013, most prescribers were required to consult the PMP Registry when writing prescriptions for Schedule II, III, and IV controlled substances.
In addition to I-STOP, New York’s legislation made it one of the first states to mandate electronic prescribing (e-prescribing) for all controlled substances with limited exceptions. The legislation also expanded the functions of a workgroup established by the Department of Health under the existing Prescription Pain Medication Awareness Program with the goal of increasing education among healthcare providers about the potential for abuse of controlled substances, and the proper balancing of pain management with abuse prevention.
Healthcare provider education is now mandatory in New York, where those licensed to prescribe controlled substances, including medical residents who prescribe controlled substances under a facility DEA registration number, must complete at least three hours of course work or training in pain management, palliative care, and addiction. The initial deadline for the completion of the course work or training was July 1, 2017, and then once every three years thereafter. Prescribers licensed on or after July 1, 2017, must complete their course work or training within one year of registration, and then once within each three-year period thereafter.
New York City also recently announced a lawsuit against eight companies that make or distribute opioids, joining a growing list of cities and states across the country that are attempting to hold drug manufacturers and distributors at least partially responsible for actions that many believe contributed to this epidemic. The lawsuit seeks $500 million in damages, money that Mayor Bill De Blasio says will be used to help fight the crisis.
In a sign that these lawsuits may be starting to influence how drugmakers market opioids, Perdue Pharma, the maker of OxyContin, announced on February 10, 2018, that it will no longer promote OxyContin to physicians. According to The Associated Press, the company “acknowledged that its promotions exaggerated the drug’s safety and minimized the risks of addiction.” While this is a welcome, albeit long overdue, acknowledgment, there is no indication if other pharmaceutical companies will follow suit.
Lawsuits aimed at forcing the drug industry to take ownership of its role in this crisis are just the beginning. As states look for creative ways to mitigate the toll of opioid abuse, physicians must be part of these discussions. To that end, on the national level the ASA partnered with the hospitals of Premier Inc. to launch a national opioid safety pilot. The six-month pilot, which began in September 2017, is geared toward addressing opioid misuse, dependence and addiction by improving pain management and reducing opioid prescriptions after surgery.
The ASA also collaborated with the CDC on “Guidelines for Prescribing Opioids for Chronic Pain,” which provides recommendations for primary care providers on opioid prescribing as well as information regarding the risks of opioid use. In addition, the ASA is working with other pain societies, through the Pain Care Coalition, to support policies to further responsible pain care.
Where do we go from here? The opioid crisis was finally declared a public health emergency in late 2017; however, no new resources were allocated on a national level to combat this epidemic. Tragically, while we wait for federal authorities to take action, thousands more will die. As experts in pain medicine, physician anesthesiologists are in a unique position to influence local and national efforts to curb opioid abuse and save lives. We welcome the input and ideas of all NYSSA members, and hope to share your constructive feedback in future issues of Sphere
Sphere is published four times per year by the New York State Society of Anesthesiologists, Inc.
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