Doctors rethinking narcotics

Dealing with the opioid misuse epidemic in the country is being addressed in a preventive way through new procedures by medical professionals, according to a Tamaqua doctor.

Dr. Joanne Calabrese, an internist with the St. Luke’s Physicians Group, gave a perspective on the current opioid crisis from the viewpoint of a physician at a presentation Wednesday morning in Founder’s Hall at Trinity United Church of Christ in Tamaqua.

The talk, co-sponsored by the Tamaqua Rotary Club and Tamaqua Area Chamber of Commerce, was attended by about 20 people, some who deal with the opioid abuse problem in medical, community and law enforcement areas.

Calabrese, referring to a 2016 Centers for Medicare & Medicaid Services Opioid Misuse Strategy, said, “The rules and the guidelines are changing, so it’s been challenging as a provider to know what the next step is, what’s going to happen, and how we’re going to guide our patients.”

The report was released on Jan. 5, 2017, and its executive summary minces no words of the enormity of the problem, particularly in the population served through Medicare and Medicaid.

Fast-growing use

“The U.S. Surgeon General recently alerted 2.3 million health care practitioners to the scope of the problem and urged them to visit TurnTheTideRx.org to join the movement to address the opioid epidemic. The message to providers pointed out that the number of opioid prescriptions written each year has quadrupled in less than two decades, yet pain reported by Americans has not changed during that time period.

Now, after two decades of increasing prescriptions, nearly 2 million people suffer from prescription opioid use disorder.

The Medicare population has among the highest and fastest-growing rates of diagnosed opioid use disorder, currently at more than 6 of every 1,000 beneficiaries. For Medicaid beneficiaries, the prevalence of diagnosed opioid use disorder is even higher, at 8.7 per 1,000, a figure estimated to be over 10 times higher than in populations who receive coverage under private insurance companies. Because there is no systematic policy of screening for opioid use disorder and patients are unlikely to volunteer that they are misusing their medication or are using opioids like heroin because of discrimination and stigma, these rates are likely underestimates.”

Even when used as directed, opioids contribute to overdose or lead to development of substance use disorder in some people, according to the study.

The high potential for misuse of opioids has led to alarming trends across the United States, including record numbers of people developing opioid use disorders, overdosing on opioids, and dying from overdoses.

In 2009, deaths from drug overdose, including heroin and prescription opioids, surpassed motor vehicle crashes as the leading cause of injury death in the U.S., and numbers have continued to rise.

“In 2015, opioids, including prescription opioids and illicit opioids such as heroin, killed more than 33,000 people — the highest number in recorded history. Additionally, 2015 statistics for methadone related deaths shows an increase in the 65-year-old population.” according to the study.

Prevention

To help prevent prescription drug abuse and protect the health and safety of our community, the state’s Prescription Drug Monitoring Program collects information on all filled prescriptions for controlled substances. The information helps health care providers safely prescribe controlled substances and helps patients get the treatment they need.

The drug monitoring system is being integrated with the electronic health records and pharmacy management systems of all eligible health care entities in Pennsylvania. The system is also sharing data with 11 other states and the District of Columbia, helping doctors and pharmacists to get a more complete picture of their patients’ controlled substance prescription histories, regardless of which state they filled their prescription in.

Calabrese showed and explained various forms to be completed to keep track of drugs being prescribed, stating that the reporting procedures are specific.

“The ramifications from a provider’s standpoint, and it is the fear I have as well, that providers are starting to feel ‘Are we doing something wrong?’ and then they’re not prescribing narcotics,” Calabrese said.

“The last article I read about this during the summer said about 30 percent of providers have stopped providing narcotic prescriptions. They won’t provide narcotics. Is that the solution? No, that is not the answer. Now there is the fear that if somebody is watching, how much is too much? What are we going to do? So, it’s a constant evolution.”

She said there are regular reviews about dispensation of narcotics and how patients are using them and obtaining them from pharmacies, along with having patients contacting the physician’s office on any changes.

Pain management changing

Calabrese also said health insurance providers are also setting guidelines on the level of drugs for pain management.

“As of Aug. 9, for anybody who is a new patient to controlled substances, they can’t get any more than 90 milligrams combined, and that means any narcotic,” Calabrese said. “And on Oct. 1, they cut down for people who had regular prescriptions and set a standard.”

The types of medications for pain management has been changing, Calabrese explained.

“Pain management’s primary focus is not prescription drugs anymore,” she said. “They are doing more intermodalities. That’s a great thing. I try to tell people that if you go by the regimen, you are going to feel better.”

The system to manage the use of medications is to help make some effective changes for the patients.

“It (the system) is really changing quickly, so this is not only of professional value to me. I have an 8-year-old and I want Tamaqua to be cleaner and safer,” Calabrese said.

“And it’s out there. We have found syringes in our parking lot. Fortunately, the police in Tamaqua are on it. We can call them and they will come, take that syringe and test it. And because of all of you (referring to the attendees), I have seen some really great progress, but I think we have a long ways to go.”

Download the drug survey at www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/CMS-Opioid-Misuse-Strategy-2016.pdf.