Gary Mendell of Shatterproof focuses totally on solving this epidemic. He realizes he cannot have a 100% success rate, but he believes we can reduce this crisis facing our country by half in a few short years with very little additional funding as he outlined to the Presidential Commission headed by Governor Christie.
One means is obviously to cut down the quantity of opioids that are legally supplied. The CDC (Centers for Disease Control and Prevention) has announced that the amount of opioids prescribed peaked in 2010 and has fallen each year through 2015. This is a good start, but the level of prescribed opioids is still three times the amount that were handed out in 1999. Per the CDC, the amount of opioids prescribed in 2015 was still enough for every American to be medicated around the clock for three weeks.
One of the means to control the outflow is through the registration of doctors reporting their prescriptions to a statewide database. Forty-nine states have established a prescription drug monitoring program (PDMP). Missouri Governor Eric Greitens ordered the formation of one in his state — the last one to form a database.
Dr. Phil Kurzner told me about how this works in California. He said it takes some effort on the part of the physician, particularly in the context of their (typically) very busy work day. In one version, the physician enters the electronic order for a restricted opioid. A text message with a code to enter is then received, much like other code-based systems used to validate the identity of the user. This is to assure that the system is tamper-proof and only the registered subscriber is on the system. Kurzner stated similar efforts are underway not just in California, but throughout the country. He predicted this will become mandatory soon. This also allows tracking of both the prescriber authorizing the opioid and the patients receiving them.
The only medications that need be reported to the database are Level II, III, and IV drugs. These drugs include morphine, methadone and other opioids.
Kurzner, who was never a heavy prescriber of opioids despite being a surgeon, does see advantages to the electronic system. He stated “Physicians can go on the website and check whether the patient has a history of doctor/pharmacy shopping for these drugs. Also, I think it makes the doctor think more carefully before issuing the drugs to make sure they are not overprescribing.” Kurzner thinks there is a relatively small number of docs who are guilty of overprescribing. Whatever the physician’s motivations, patterns and trends in prescribing can quickly identify heavy prescribers. The best justification for heavy prescribing of opioids would be surgeons on a short-term basis after invasive, acutely painful surgeries. There is also a clear role for physicians who specialize in acute pain management situations.
A common example is the cancer patient, with spreading of cancer to bones or other body parts causing severe pain. Kurzner stated “There is growing consensus among practicing physicians that the use of opioids in chronic pain management is not optimal. There are better therapies now for these situations, reducing the risk of addiction from often times well intended prescribing of opioids.”
Other than reporting their prescriptions to a database, there are some basic common-sense suggestions from the CDC for health care professionals:
Use opioids only when benefits outweigh risks:
· Start with the lowest effective dose of immediate release opioids.
· For acute pain, prescribe only the number of days that the pain is expected to be severe enough to require opioids.
· Reassess benefits and risks if considering dosage increases.
The idea is that a doctor should be seriously thinking about each prescription before signing that pad.
Mendell made a series of recommendations to the Presidential Commission headed by Governor Christie in addition to use of the PDMP system. Let us summarize those recommendations:
1. Shatterproof believes the focus should be on treatment for opioid addiction:
80% of those receiving treatment do not receive medical treatment which is the…