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

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The Opioid Crisis in 2019

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.

 

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Proposed Federal Opioid Law Aims to Tackle Growing Problem

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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.”

 

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Prescription Opioid Summit Asks Doctors to be Proactive  

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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.”

 

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Dr. Taufiq Ahmed on Changes in Opioid Laws

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Opioid laws are changing around the nation – tightening the amount and duration of prescriptions doctors can write. Congress has allocated $6 billion towards the epidemic for 2018 and 2019, but it’s unclear how the money will be spent at this point.

Florida’s bill would limit opioid prescriptions to three days, though seven-day supplies would be permitted if a physician deems them medically necessary. The restrictions wouldn’t apply to patients suffering pain related to cancer, terminal illness, traumatic injuries or palliative care.

The goal of the new law is to help prevent people from getting addicted to prescription opioids. Earlier restrictions on prescriptions, and higher costs, have been shown to lead to some patients to switch to cheaper, more plentiful street drugs like heroin and fentanyl.

The impact of the new law is a hot topic among pain management physicians and their patients. Taufiq Ahmed, M.D., principal pain specialist at Physician Partners of America Pain Relief Group – Orlando, recently talked with Spectrum My News 13 in Orlando about the sweeping changes in Florida’s opioid laws. While he understands the need for more regulation, Dr. Ahmed and his peers are concerned about the unintended consequences that legitimate chronic pain sufferers could face.

“It’s been a little frustrating for us pain providers as well because we realize not every injury is a three-day or a seven-day situation,” he said.

Ahmed, an anesthesiologist as well as a pain management physician, gets to the root cause of the pain in the PPOA tradition, and treats it with a number of modalities. This may include injections, radiofrequency ablation, nerve blocks and spinal cord stimulator implants. He also incorporates alternative methods to help reduce the chance a patient develops a dependence on opioids.

“Everyone has good intentions in mind, and to be frank the issues with the amount of heroin and opioid overdoses we’re seeing in Florida is staggering,” he said.

 

Read the full article: SPECTRUM NEWS 13: Florida’s opioid legislation causes concern amongst pain sufferers

 

 

 

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