APA Calls for Better Training to Treat Chronic Pain, Addiction Among Vets

military“Pain management, addiction detection, and effective treatment are significant priorities for the nation’s veterans, and these objectives require better coordination of opioid and benzodiazepine prescribing inside and outside the Veterans Health Administration (VHA).

That’s what the American Psychiatric Association (APA) CEO and Medical Director Saul Levin, M.D., M.P.A., told the House Veterans Affairs Committee in a written statement about management of chronic pain and addiction to painkillers among veterans. The statement was in response to a House hearing titled “Between Peril and Promise: Facing the Dangers of VA’s Skyrocketing Use of Prescription Painkillers to Treat Veterans.”

Levin focused on veterans and the returning military population, but noted that issues such as medication diversion, medication seeking, improper prescribing, inadequate informatics on prescription utilization, and the need for better pain management and utilization of medical options to assist with substance use disorders are prevalent for the United States population as a whole.

He outlined four overarching recommendations: the use of prescription drug management plans (PDMPs) and the need for coordination between the (VHA’s PDMP and state-based plans, the need to recruit and retain more psychiatrists within the VHA, training the VHA workforce in evidence-based pain management and addiction treatment, and the need for new research on pain medications.”

http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1793814

Source: PsychiatryOnline.org – September 19, 2013

AMA Calls on CDC to Help Combat Prescription Drug Abuse

pills 12-20-12“At the American Medical Association (AMA), physicians voted to support a proposal for a more practical approach in preventing death from prescription pain medications.

Specifically, the proposal calls on the Centers for Disease Control and Prevention (CDC) to help provide required information in order to develop appropriate solutions.  The AMA will urge the CDC to promote a standard approach for “documenting and assessing deaths involving controlled substances for pain relief,” stated Patrice Harris, MD, an AMA Board Member.

According to the AMA, the CDC is in a key position to promote a standard approach that can help identify key trends and guide effective preventive measures. A standardized method of data collection and analysis has helped public health officials, law enforcement, and policy makers address other national epidemics.”

Source: American Medical Association – November 19, 2013

National Rx Drug Abuse Summit Focused National Attention, Efforts on Addressing Prescription Drug Abuse Issues

ROUND PILLSThis article provides an excellent recap of the second National Rx Drug Abuse Summit held April 2-4, 2013, in Orlando, Florida. Nearly 900 people from 49 states and two other countries attended the conference.

“A national outcry about the human cost of prescription drug abuse is needed if efforts to stop this national epidemic are to be successful. People of great passion and perspective are here wanting to make an impact in their communities,” said Congressman Harold “Hal” Rogers (KY-5th), chair of the U.S. House Committee on Appropriations, whose efforts to address prescription drug abuse have been recognized nationally.

“The first step is we have to admit there is a problem,” said Rogers, co-founder and co-chair of the Congressional Caucus on Prescription Drug Abuse. “I don’t think the country is there yet. We’ve got to face up to it. We’ve got to make this known … and that we’re not going to hide from it.”

http://www.workerscompensation.com/compnewsnetwork/news/16481-national-rx-drug-abuse-summit-focused-national-attention-efforts-on-addressing-prescription-drug-abuse-issues.html

Source: WorkersCompensation.com – April 12, 2013

Rockefeller Urges Federal Agencies to Take Stronger Steps Against Prescription Drug Abuse

prescription drugsSen. Jay Rockefeller, D-W.Va., is asking three federal agencies to step up efforts to
counter prescription drug abuse, an increasing problem in West Virginia.

Rockefeller wrote to the Government Accountability Office, the Centers for Medicare
and Medicaid Services and the U.S. Food and Drug Administration (FDA).

He requested that the GAO study the neonatal abstinence syndrome. He asked the Centers for
Medicare and Medicaid Services for information about how the agency monitors prescription
drug abuse by people on Medicaid and Medicare. Rockefeller also asked the FDA about efforts
to improve education about methadone for both patients and those who prescribe it.

http://wvgazette.com/News/201302130117

The press release can be accessed at: http://www.rockefeller.senate.gov/public/index.cfm/
press-releases?ID=649103fe-024e-4edf-8435-df52251216cd

Source: WVGazette.com – February 12, 2013

National RX Drug Abuse Summit in Orlando FL April 2-4 2013

The 2013 National Rx Drug Abuse Summit will focus on ways to make an Impact in the fight against prescription drug abuse. The Summit is the largest national collaboration of professionals from local, state, and federal agencies, business, academia, clinicians, treatment providers, counselors, educators, state and national leaders, and advocates impacted by Rx drug abuse.

The Summit will be held in Orlando FL April 2-4 2013.

Keynote speakers include R. Gil Kerlikowske, Director, White House Office of National Drug Control Policy (ONDCP), and Dr. Nora D. Volkow, Director, National Institute on Drug Abuse (NIDA)

http://nationalrxdrugabusesummit.org/

The December 2012 issue of Heroin Addiction and Related Clinical Problems is Now Available Online

Heroin Addiction and Related Clinical Problems, the official journal of EUROPAD (European Opiate Addiction Treatment Association), is a peer-reviewed publication for professionals wanting to stay informed of research and opinion on opioid misuse treatment in Europe and around the world. A particular emphasis is on medication-assisted treatments for opioid addiction. Articles in this issue include:

  • Quality of Care Provided to Patients Receiving Opioid Maintenance Treatment in Europe: Results from the EQUATOR analysis
  • Outcomes of opioid-dependence treatment across Europe: identifying opportunities for improvement
  • Assessing the current state of public-health-related outcomes in opioid dependence across Europe: data from the EQUATOR analysis
  • Barriers to treatment access and informed patient choice in the treatment of opioid
    dependence in Europe
  • Aggressive behaviour and heroin addiction
  • Post-traumatic stress spectrum and maladaptive behaviour (drug abuse included) after catastrophic events: L’Aquila 2009 earthquake as case study

The PDF file is available for download at: http://atforum.com/documents/HeroinDecember2012.pdf

State Drug Monitoring Programs Should Make Data More Accessible, Study Says

 Currently, data from the Prescription drug monitoring programs (PDMP) are not used as much as they could be, cannot be easily exchanged across states, and are difficult for providers to find, a new government report states. Five to 39 percent of providers use PDMP data, according to the report. Reasons for the low usage include many providers are not aware of the systems, and the data is not current. In addition, members of healthcare teams that support doctors and pharmacists often are not allowed to access the systems.|
 http://www.drugfree.org/join-together/prescription-drugs/state-drug-monitoring-programs-should-make-data-more-accessible-study-says?utm_source=Join+Together+Daily&utm_campaign=538ae1e9a7-JT_Daily_News_State_Drug_Monitoring&utm_medium=email

Source: JoinTogether.org – December 6, 2012

Blog: Benzos at the Opioid Treatment Program

“Should patients in opioid treatment programs ever be approved to take benzodiazepines? Even addiction medicine doctors hold widely varying opinions on this issue. In my state (North Carolina), all of the doctors who work in opioid treatment programs are invited to participate in a conference call once per month. The people who head the state’s methadone authority and the Governor’s Institute on Substance Abuse are also usually on the call. We discuss difficult issues we’re facing, and discuss difficult cases. Last month, the question was asked pointedly by one of the doctors: “Is zero-tolerance for benzodiazepines now the standard of care for opioid treatment programs in our state?” For the people on this call, the consensus was that the ideal was zero tolerance or at least a restricted policy regarding benzodiazepine use.”

The blog is available at: http://janaburson.wordpress.com/2012/11/03/benzos-at-the-opioid-treatment-program/

Source: Janaburson’s Blog – November 3, 2012

As Prescription Painkiller Overdoses Mount, Researchers Outline Effective Approaches to Curb Epidemic

Prescription painkillers are responsible for more fatal overdoses in the U.S. than heroin and cocaine combined. And while most states have programs to curb abuse and addiction, a new report from Brandeis University shows that many states do not fully analyze the data they collect.

Experts from the Prescription Drug Monitoring Program (PDMP) Center of Excellence at Brandeis University’s Heller School for Social Policy and Management systematically assessed prescription drug monitoring programs and found a patchwork of strategies and standards. Their report also outlines best practices that all U.S. states and territories can use to improve their effectiveness.

Among the study’s primary conclusions: prescription drug monitoring programs should shift from a reactive to a proactive approach.

“Being proactive is the key to success in the fight against prescription painkiller abuse,” said John L. Eadie, Director, PDMP Center of Excellence at the Heller School for Social Policy and Management, Brandeis University. “While doctors may routinely collect and report data to a state program that signals where and when prescription painkillers are likely being misused, the program might not share that information with others who can best use it.”

The press release can be accessed at: http://www.pewhealth.org/news-room/press-releases/as-prescription-painkiller-overdoses-mount-researchers-outline-effective-approaches-to-curb-epidemic-85899418402

The full report can be accessed at: http://www.pewhealth.org/reports-analysis/reports/prescription-drug-monitoring-programs-an-assessment-of-the-evidence-for-best-practices-85899418404

Source: PewTrusts.org – September 20, 2012

AATOD Issues Prescription Monitoring Program Guidelines for OTPs

The American Association for the Treatment of Opioid Dependence (AATOD), issued guidance this June to opioid treatment programs (OTPs) encouraging them to “utilize prescription monitoring programs (PMPs) as an additional resource to maximize safety in patient care pursuant to applicable state guidelines.”

When OTPs do access state PMP data bases, they should do so for therapeutic reasons, not for the purpose of restricting access to treatment, according to AATOD. “OTPs are discouraged from using such data for the sole purpose of restricting treatment access or for responding in a punitive fashion to the needs of patients in treatment.”

OTPs Should Not Report Confidential Data

OTPs, because of confidentiality law applying specifically to treatment for addiction, should not report anything that could identify their patients to PMPs, said AATOD, citing guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA). Under 42 CFR Part 2, the federal regulation protecting the confidentiality of substance abuse treatment records, treatment programs may not divulge patient-identifying information without the patient’s written, specific consent. That was the point SAMHSA’s H. Westley Clark, MD, JD, was making in his September 27, 2011 Dear Colleague letter (See AT Forum Fall, 2011). SAMHSA administers 42 CFR Part 2.

However, no patient consent is required for the OTP—or anyone else—to request information from the PMP about a patient. Under 42 CFR Part 2, making such a request does not constitute disclosing a patient’s status as a substance abuse treatment patient.

But AATOD does recommend that OTPs notify a patient when they are accessing a PMP database, even though SAMHSA says this isn’t necessary. “The OTP should inform patients that they are accessing PMP databases by posting information or by distributing information to patients, explaining what a PMP does and why the program is requesting the data,” according to AATOD.

SAMHSA is expected to issue additional guidance on PMPs to OTPs.

According to AATOD, there are concerns that some people want to weaken 42 CFR Part 2 to make it possible for other physicians to access information about OTP patients. “As I understand it, someone from the Centers for Disease Control and Prevention may have recommended this idea about one year ago,” Mark W. Parrino, MPA, AATOD president, told AT Forum in an e-mail. “I also know that a number of physicians who work in emergency rooms have made similar recommendations.”

If a PMP re-discloses identifying data to interested parties about a patient, individuals could be discouraged from accessing medication-assisted treatment, according to AATOD.

So far, 49 of the 50 states either have active PMPs or legislation approving the use of PMPs.

The AATOD Guidance document can be accessed at: http://aatod.org/guidance_to_otps.html

PMPs Need to be More ‘User-Friendly’ for Physicians, Study Finds

There are barriers to prescribers’ use of prescription monitoring programs (PMPs), according to researchers from the American College of Medical Toxicology (ACMT). In a June 21 New England Journal of Medicine Perspective article, Jeanmarie Perrone, MD, and Lewis Nelson, MD, found that PMPs, with some simple improvements, could be much more useful to physicians.

The most frustrating aspect of PMPs is the time it takes to use these programs. “Even if it takes only three minutes per patient, in a busy emergency department or office practice, having to do this multiple times daily amounts to a substantial time investment,” said Dr. Lewis in a press release from the ACMT. Much of the time is spent navigating to the correct web portal, they found. The physicians need to recall the password—and reset it. And many physicians found that once they did gain access, up-to-date information was not available for each patient.

Because time is the major barrier to physician use of PMPs, it would be helpful to have programs be more user-friendly, the researchers found.

Despite the barriers, the potential benefits of PMPs are great, the researchers said, noting that with enhancements to systems, these programs may help reduce prescription drug abuse.

For the research, Drs. Perrone and Lewis looked at opioid prescribing practices of ACMT members, and presented their results at the March national meeting.

For the free full-text article, go to http://www.nejm.org/doi/full/10.1056/NEJMp1204493

Federal Government Tests New PDMP Projects in Indiana and Ohio

A new pilot program launched by the federal Department of Health and Human Services (HHS) will make prescription drug data available to prescribers and pharmacists in both ambulatory and emergency departments in Indiana and Ohio. The pilot projects, which will be run by the Office of the National Coordinator for Health Information Technology (ONC), will measure how expanding prescription drug monitoring programs (PDMPs), as the government refers to them, will help reduce prescription drug abuse.

Farzad Mostashari, MD, national coordinator for Health Information Technology (Health IT), said that the pilot projects will help emergency department staff identify a patient’s controlled substance history “at the point of care, to enable better targeting appropriate treatments and reduce the potential of an overdose, or even death.”

“Technology plays a critical role in our comprehensive efforts to address our nation’s prescription drug abuse epidemic,” said Gil Kerlikowske, director of The Office of National Drug Control Policy (ONDCP), in a press statement issued June 21 as the programs were launched. “We hope these innovative pilots will help usher in an era of ‘PDMPs 2.0’ across the nation,” he said. The goals are to improve real-time data sharing, increase interoperability among states, and increase the number of people using PDMPs.

http://www.govhealthit.com/news/onc-tests-health-it-reduce-prescription-drug-abuse

Congressional Research Service Report on Prescription Drug Monitoring Programs

The Congressional Research Service has created a report for Congress on Prescription Drug Monitoring Programs (PDMPs).  The report issued in July provides an overview of prescription drug abuse, overview of current PDMPs, PDMP effectiveness, Federal grant programs for PDMPs, and information on some key policy issues such as balancing stakeholder concerns.

The available evidence suggests that PDMPs are effective in reducing the time required for drug diversion investigations, changing prescribing behavior, reducing “doctor shopping,” and reducing prescription drug abuse; however, research on the effectiveness of PDMPs is limited.

Assessments of effectiveness may take into consideration potential unintended consequences of PDMPs, such as limiting access to medications for legitimate use or pushing drug diversion activities over the border into a neighboring state. Experts suggest that PDMP effectiveness might be improved by increasing the timeliness, completeness, consistency, and accessibility of the data.

The report can be found online at:  http://www.fas.org/sgp/crs/misc/R42593.pdf

Source: Congressional Research Service – July 11, 2012

RI Hospital: Use of PMP May Increase Demand for Drug Treatment, Reduce Painkiller Abuse

A Rhode Island Hospital researcher has found that the use of electronic prescription drug monitoring programs (PMPs) may have a significant impact on the demand for drug treatment programs and how prescribers detect and respond to abuse of painkillers. The study by Traci C. Green, PhD, MSc, research scientist in Rhode Island Hospital’s department of general internal medicine is published in the journal Pain Medicine.The study found that prescribers’ use of an electronic PMPs may influence medical care and decisions, especially with opioid abuse detection, and is associated with clinical responses to suspected doctor shopping or diversion.

When prescribers suspected a patient of doctor shopping or diverting medications, PMP users were more likely to ramp up clinical monitoring with urine drug screens or refer the patient to drug treatment. PMP users were also less likely to ignore the warning signs or to call law enforcement.

“One thing is clear,” Green said, “Clinicians, not law enforcement, have the medical and behavioral health care expertise to guide patients struggling with addiction to get the help they need, when they are ready for it. PMPs can be an important clinical tool to address possible addiction issues and start that conversation.”

Green added, “Our study suggests that if states want wider use of PMPs by their prescribers, we need to increase access to drug treatment, especially opioid-dependence treatment options, if we are going to make headway on the epidemic of painkiller abuse and overdose death in our communities.”

http://www.rhodeislandhospital.org/wtn/Page.asp?PageID=WTN000287

Source: – Lifespan – August 16, 2012

Kentucky – Prescription Drug Abuse Bill Making Its Mark Just Days After Going Into Effect, Officials Say

prescription drugsDays after a landmark prescription drug abuse law took effect, the law appears to have already effected changes in the medical field and positioned Kentucky as a leader in battling prescription drug abuse.

“The enforcement of this bill began just a couple of days ago, and yet we already know that four ‘pain management clinics’ in Kentucky have waved the white flag and notified us they will shut their doors,” said Gov. Steve Beshear, who joined Attorney General Jack Conway, lawmakers and medical providers in hailing the law’s impact.

House Bill 1, sponsored by House Speaker Greg Stumbo, passed in a special legislative session this spring. The bill included multiple elements to prevent the abuse and diversion  of prescription drugs and to enhance law enforcement’s tools to investigate illegal prescribing practices.

“We know that more than 9,000 medical providers have signed up for electronic prescription monitoring just since this law passed in April – more than doubling the number registered.

http://www.kyforward.com/2012/07/prescription-drug-abuse-bill-making-its-mark-just-days-after-going-into-effect-officials-say/

Source: KYForward.com – July 25, 2012

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