Make Pain a Thing of the Past – Opioid Crisis – Physician Partners of America

Tag Archive for: Opioid Crisis

Window sign was unauthorized, untrue

Physician Partners of America (PPOA) as an organization is sensitive to the current backlash to the opioid crisis and the new prescribing laws that have resulted. We recognize a growing movement of law abiding chronic pain patients who rely on long-term “maintenance” doses of opioid pain medication.

In particular, we would like to address a sign that was placed in the window of one of our practices on May 14, implying that we will cease prescribing opioid medication to patients as of May 31, 2019.

Patients are and will continue to be titrated down according to CDC guidelines; however, there is no cut-off date.

This sign was brought to our attention through social media. It was in no way authorized or approved by management, and its message is untrue. It resulted from an employee’s misinterpretation of our goal to reduce opioid dependence.

At its foundation, PPOA uses interventional pain management modalities to treat pain at its source instead of masking it with medication. Our physicians come to our organization with a variety of backgrounds and use many modalities to treat chronic pain. They are medical pioneers like Dr. Phillip Kravetz, researchers like Dr. Neil Ellis and Dr. Michael Lupi, and inventors like Dr. Lesco Rogers.

Treatments may include Stimwave, trigger point injections, nerve blocks, minimally invasive spine procedures with and without laser assistance, Botox injections for migraines, neuromodulation and regenerative medicine. Physicians may also utilize a variety of medications – including topical, oral and intrathecal – to reduce pain.

We use pharmacogenomics to determine the safest dosage and medication type based on each patient’s genome, and intraoperative neuromonitoring

We have championed remedies to the opioid crisis in public forums, in the media, in televised town halls and at medical conventions. PPOA physicians strictly follow the prescribing laws of the states in which they operate.

We recognize the opioid crisis backlash. As an organization, we sympathize with the plight of people who rely on, but who do not intentionally abuse, prescription opioid medications to manage their chronic pain. We aim to show them what we consider a better, safer way to reduce or eliminate pain.

We will continue to engage in serious, thoughtful discussions toward finding a middle ground that balances patient concerns, federal guidelines and state laws.

We thank the public for input on this sensitive topic and invite you to learn more about who we are and what we do on our website.

 

Could this be the year that turns the tide of the opioid crisis?

Opioid overdose deaths, which reached 47,600 across the nation in 2017, continue to ravage many parts of the country. New laws and new ways of looking at pain management are offering glimmers of hope.

The use of opiate drugs continues to skyrocket; however, healthcare and law enforcement agencies aim to stem the opioid crisis by finding alternatives to pain medication, expand treatment and stop overdose deaths. So far, there are only patchwork solutions, but they show promise.

Many addictions start in the physician’s office. PPOA distinguishes itself by focusing on interventional pain management procedures, and such minimally invasive procedures as laser spine surgery and SI joint injections.

For patients who come to PPOA clinics already taking opioids for chronic pain, PPOA has long relied on medication management and pharmacogenomics, a drug-genes test that ensures each patient gets the right dose of genome-compatible medication.

Drug genes testing is now being used by other respected healthcare operations like Mayo Clinic and Cleveland Clinic.

Legislation to fight opioid abuse

As of October 2018,  at least 33 states have enacted legislation related to opioid prescription limits. Different communities around the nation are taking different approaches to stem the tide of addictive painkillers.

Last July, Florida lawmakers enacted stiffer rules governing prescriptions, and allocated $60 million toward treatment resources and a wider availability of the opioid antidote naloxone. Read more about the law.

In Texas, prescriptions now contain advanced security features to prevent fraud during the filling process. As of June 1, 2019, doctors will have to order new prescription forms and join the states’ prescription monitoring program (PMP), known as PMP Aware. This allows physicians to check a patient’s prescription history for information related to drug abuse and doctor shopping.

In Ohio, the Cincinnati area has cut opioid deaths by over 30 percent in six months since widely handing out Narcan, a nasal spray form of the opioid antidote Naloxone, to the public.

While naloxone remains controversial – it doesn’t prevent addiction – its use has increased around the nation. PPOA offers it with every painkiller prescription. In Burlington, Vermont, the mayor and police chief have teamed up to arm law enforcement, emergency workers and the public with the antidote.  The state is also focusing on long-term treatment, as are others.

In Rhode Island, a program providing recently released inmates with medication-assisted treatment has cut overdose deaths by more than 60 percent.

Finally, the federal government has taken steps to fight the opioid crisis. The SUPPORT for Patients and Communities Act, passed Oct. 3, 2018, took effect Jan. 1. Among other measures, it creates grants for more addiction recovery centers, expands naloxone access, and focuses on best practices in prescribing.

While it’s too early to tell which approach will work, PPOA continues to lead the way by focusing on non-opioid pain treatments and personalized medicine.

 

Bill Has Rare Bipartisan Support –

Update: President Trump signed the bill into law Oct. 24.

A proposed federal opioid law addressing the opioid crisis would increase access to treatment for addiction, open the door for non-opioid therapy, and limit over prescription of narcotic painkillers.

On October 3, in a rare show of bipartisanship, Congress passed the SUPPORT for Patients and Communities Act. The bill was approved by a vote of 98 to 1 in the Senate and 393 to 8 in the House of Representatives. The opioid legislation is expected to be signed into law by President Donald Trump and take effect Jan. 1.

With an opioid-related death toll at 700,000 and rising since the 1990s, Physician Partners of America (PPOA) applauds the proposed federal opioid law.

“Pain management specialists are at the forefront of combating this national problem,” said Abraham Rivera, M.D., chief medical officer of Physician Partners of America. “We embrace the actions of congress and will incorporate the resources the law provide for the welfare of our patients.”

The company stresses its interventional pain management approach, which treats the root of  pain problems, over masking symptoms with opioid medication.

The far-reaching legislation package is aimed at changing the way the United States approaches the addiction issue. Provisions include:

  • Creating a grant program for opioid recovery centers to address treatment and recovery
  • Allowing more health care practitioners to prescribe opioid addiction medications
  • Expanding the availability of naloxone, a medication that reverses overdoses, to first responders
  • Allowing government agencies to pursue addition and pain research projects
  • Educating a wider group of health care providers about best practices in pain management

The new federal opioid law aims to limit overprescription of opioid painkillers to Medicare and Medicaid recipients, and expands access to addiction treatment within those programs

“The Centers for Medicare & Medicaid Services’ reimbursement for common pain management procedures are also going up because of this,” said Luis Nieves, M.D. PPOA’s Hurst, Texas pain management specialist.  “Hopefully private insurance will follow and improve access for all patients.”

 

Peer-approved prescriptions, drug-gene testing and electronic prescribing may be the wave of the future in the war on prescription opioid abuse. Those were some of the key takeaways for more than 60 physicians from around Florida at a recent Opioid Summit. Dr. Abraham Rivera, chief medical officer of Physician Partners of America, served as presenter of the April 28 event in his role as board member of the Florida Academy of Pain Medicine (FAPM).

“The legal landscape is changing, and we need to change the way we prescribe,” said Dr. Rivera, an interventional pain management specialist and anesthesiologist.

The Opioid Summit seeks to define the scope of the growing abuse problem and ways to solve it.  Among the speakers was U.S. Rep. Gus Bilirakis, R-Florida, as well as representatives from law enforcement and the legal field. The presentations focused on responsible prescribing, transparency and alternative treatments.

Avoiding Prescription Opioid Abuse 

In the absence of uniform prescribing laws and indications, opioid painkillers should be used as a means to an end, not as an end by itself. Drug tapering and detox protocols should be used routinely and all prescriptions should follow a specific diagnosis, with no off-label prescribing. Sustained release opiates should be used no more often than twice a day. Short-acting opiates are used no more often than four times daily. Electronic prescriptions are encouraged for a variety of reasons: they provide solid documentation from the beginning of treatment and they do not get lost. There is also less potential for abuse, diversion and tampering.

Finally, the summit proposed that opioid prescription records should be monitored by a physician’s peers for review. “Accountability and transparency are key,” Rivera said.

Changes in Opioid Laws

Like many states, Florida is clamping down on prescription protocols. A new law that goes into effect July 1 limits such prescriptions to three days – seven in cases deemed medically necessary. The laws address people who suffer from acute pain, but more discussion is needed to address the needs of chronic pain patients. Those are defined as people who experience pain for more than 12 weeks.

Dr. Rivera’s take: “Every case is different, but in general, a one-month supply is reasonable for chronic patients.”

Interventional Pain Management

To Physician Partners of America, the answer lies in interventional pain management. This subspecialty of pain medicine seeks to pinpoint and treat the pain at its source without relying on prescription opioid medication.

Interventional treatment includes:

  • Epidural injections
  • Facet blocks
  • Radiofrequency ablation
  • Nerve blocks
  • Corrective surgery
  • Intrathecal pumps
  • Neurostimulation

Dr. Rivera also recommended that physicians explore alternative treatments such as Traditional Chinese Medicine, acupuncture, chiropractic and massage.

Monitoring Pain Patients

Physician Partners of America recommends performing urine drug tests (UDTs) on pain patients, starting before the first prescription is written and then when indicated. The frequency varies according to individual patient risk.

In addition, prescriptions should not be copied or given to the patients at office visits. The system is not foolproof, however. Roadblocks include lack of communication between states and the Veterans Administration, and the fact that some states do not have this system.

Legislating Opioid Prescriptions 

Recommendations include using prescription drug monitoring programs (PDMS) for every prescription. The summit’s presenters also recommended fuller implementation of the National All Schedules Prescription Electronic Reporting Act (NASPER). Enacted in 2005, this U.S. Department of Health and Human Services program gives grants to states to start or enhance prescription drug monitoring programs.

Rep. Bilirakis discussed the intent of Congress to fund programs to help with the opioid crisis across the nation. He noted that the House has passed legislation to address this issue, but the Senate has yet to bring it up for discussion.

Is Naloxone the Answer?

For those patients who are still opioid users, the summit presented an innovative approach: prescribing a companion prescription of the opioid antidote Naloxone to prevent accidental overdose. The U.S. Surgeon General recently endorsed this idea. Since its inception, PPOA has encouraged its physicians to prescribe an antidote to every patient who is prescribed an opiate in excess of 50 mg. per day of morphine equivalents.

Alternative Pain Therapies

Interventional pain management should be considered as a first course of treatment for select pain patients as an alternative to a prescription opioid. It gets to the root of the problem and provides direct relief. Interventional treatment includes:

  • Epidural injections
  • Facet blocks
  • Radiofrequency ablation
  • Nerve blocks
  • Corrective surgery
  • Intrathecal pumps
  • Neurostimulation

Intraoperative Neuromonitoring (IONM)

Intraoperative neuromonitoring is also being used to reduce pain following surgery and, therefore, the use of narcotic painkillers post-operatively. IONM is designed to minimize neurological damage during surgery. It identifies changes in brain, spinal cord, and peripheral nerve function prior to accidental, irreversible damage.

Pharmacogenomics

Medication efficacy is determined in part by genetics. What works for one person is likely to be different form another. Drug-genes testing is routine at PPOA, ensuring that the safest doses of the right medications are administered.

The ideas presented at the summit are likely to spark further discussion at the FAPM’s annual conference in July at the Orlando Grand Hyatt. And while approaches differ, pain management physicians are changing their way of thinking about a prescription opioid as a first course of treatment.

“Opiates should be used as a means to an end,” Dr. Rivera said, “and not as an end by itself.”

 

The Commission on Combating Drug Addiction and the Opioid Crisis found that in the last 17 years, the number of opioid overdoses in the U.S. has increased four-fold, aligning with the number of opioid prescriptions sold. That’s no coincidence.

While opioid abuse remains a complex and burgeoning problem, the fallback solutions are avoiding the need for opiates in the first place and curtailing the amount a physician can prescribe. In addition, nearly every state has adopted a medication management program that allows regulators and doctors to track the number of opioids prescribed.

Another solution that flies under the public radar is familiar to surgeons: a piece of equipment that works quietly in the corner of many an operating suite, known as intraoperative neuromonitoring (IONM).

Neuromonitoring for Interventional Pain Procedures

IONM monitors electrical potentials from the patient’s nervous system during surgery involving the brain, spine and other parts of the body. In real time, the certified IONM technician can monitor and evaluate the function of the patient’s brain, spinal cord and nervous system. Intraoperative neural monitoring offers a set of eyes more accurate than the standard visual and x-ray assisted methods. It can detect nerve injuries before they reach a level that could lead to prolonged or permanent damage.

How Intraoperative Neuromonitoring Reduces the Need for Opioids

Specifically, IONM helps the surgeon avoid injuries that can cause postsurgical problems such as muscle weakness, hearing loss, paralysis, and loss of normal body functions. Many of these conditions can cause pain that in some cases indicates use of narcotic pain relievers.

In study after study, IONM has been shown to reduce the need for opioids post-surgery, because it reduces nervous system complications, pain and hospital readmission.

Neuromonitoring for Safer Surgeries

As a company that puts patient safety first, Physician Partners of America has embraced this technology to become a leader in performing IONM in many types of surgeries. In the past eight months, its certified technicians have monitored more than 400 operations related to interventional pain relief alone, making PPOA a leader in this application. The company is in the process of gathering case studies for pain-related surgery monitoring.

Along with medication management and pharmacogenomic testing, IONM is one more way Physician Partners of America is leading the charge in ensuring patient safety and battling the opioid crisis.