Pa. releases guidelines for prescribing narcotics

Posted: July 12, 2014

State and medical organization officials released new guidelines Thursday for prescribing opioids, one of the first concrete steps that Pennsylvania has taken to address an overdose death rate that ranks among the worst in the nation.

After months of discussion, collaboration, and compromise, a large task force requested by Gov. Corbett last fall announced the recommendations to help doctors responsibly prescribe narcotic painkillers.

"The guidelines have a twofold mission," said Physician General Carrie DeLone, a task force cochair. "The first is to make sure physicians have the tools to make the best decisions possible for chronic non-cancer pain. And they are also part of an effort to decrease misuse."

An estimated one-third of the U.S. population suffers from chronic pain, and although there is little evidence that opioids are an effective long-term treatment, their use has escalated rapidly over the last 15 years.

Since the increase was associated with a rise in drug-related deaths - over 41,000 nationwide in 2011, including more than 2,200 in Pennsylvania - there was a need to take a closer look at prescribing habits, DeLone said.

The guidelines are voluntary. Some seem self-evident, such as a suggestion that "before initiating chronic opioid therapy, clinicians should conduct and document a history, including documentation and verification of current medications and a physical examination."

But the intent is to provide a road map for doctors who do not often treat chronic pain.

"A pain specialist is likely to have great familiarity with everything in the guidelines," DeLone said. "But a family-practice doctor might only occasionally treat a patient with chronic pain."

She said doctors now will be better equipped to design a treatment plan that involves not just medication, but physical therapy, and cognitive and behavioral components that have been shown to be effective.

It also will give doctors support when they have to lower unrealistic expectations of pills' benefits, DeLone said.

Rather than "annihilating" pain, she said, the healthier goal may be to make patients comfortable and functional.

And when a physician suspects that a patient may be abusing prescription painkillers or allowing them to fall into other hands, she added, the guidelines may make it easier to ask difficult questions.

Painkiller abuse has recently been blamed for increases in heroin deaths around the country, as some people addicted to pills move on to cheaper and more powerful heroin to avoid withdrawal sickness.

Pennsylvania has been criticized for moving slower than New Jersey and some other states that have far lower death rates. A Corbett administration initiative has placed 182 permanent "Prescription Drug Take-Back" boxes in 32 counties this year, an administration spokeswoman said, and a legislative task force will soon begin reviewing laws and regulations that touch on opioid abuse.

Pennsylvania is one of only two states that does not give physicians access to a database that could show whether their pain patients are doctor-shopping for narcotics.

A bill to create one was among several pieces of opioid-related legislation that appeared near passage last month but got mired in changes between the House and Senate. They are likely to move in the fall.

DeLone said Pennsylvania was on course and steadily making progress.

The task force that crafted the guidelines was also cochaired by Gary Tennis, secretary of the Department of Drug and Alcohol Programs, and involved more than 70 medical professionals and representatives of associations and regulatory agencies. The recommendations were announced jointly by the state and the Pennsylvania Medical Society.

They include elements of guidelines used by the American Pain Society, the Federation of State Medical Boards, and the State of Ohio.

"Very few people have had training in how to assess patients for previous abuse," said James Cleary, director of the Pain and Policy Studies Group at the University of Wisconsin. "Most physicians have not been appropriately trained in pain management."

He said Pennsylvania's guidelines "are very responsible."

The one concern that Cleary raised was that opioids remain available to those who truly need them, especially cancer patients and those who are suffering at the end of life.

DeLone said she and the others on the task force shared that concern and that finding the proper balance was critical:

"The importance of making the guidelines voluntary is that they're not designed to replace a physician's clinical judgment. We need to understand that every patient is different."



Inquirer staff writer Don Sapatkin contributed to this article.

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