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Opioid Prescribing Safety
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Forty-four people die each day in the United States from an overdose of opioids. In 2014, approximately one Arizonan died every day from an overdose due to prescription opioid pain relievers. Compared to other states, these alarming outcomes placed Arizona as the 12th highest state in the nation for drug overdose death rates in 2012 and 12th highest in prescription misuse and abuse among people 12 years of age and older. Many Arizona physicians see patients who are, or may become, part of this epidemic.

In 2012, health care providers wrote 259 million prescriptions for opioid or narcotic pain relievers such as Vicodin, OxyContin, Opana, and methadone. That same year in Arizona, there were 82 painkiller prescriptions written per 100 people. Increased prescribing of narcotics or opioid medication is associated with more overdose deaths.

In 2012, there was also a sharp increase in heroin overdose deaths. One of the factors driving the increase in heroin overdoses appears to be widespread prescription of opioids and increasing rates of opioid addiction. Research has found that approximately 3 out of 4 new heroin users report having abused prescription opioids p e same receptors in the brain to produce similar effects.

The Arizona Medical Association (ArMA) supports the work of the Arizona Prescription Drug Misuse and Abuse Initiative, and the American Medical Association (AMA) Task Force to Reduce Opioid Abuse. The AMA Task Force, comprised of more than 20 state and specialty medical associations, works collaboratively to address the opioid public health epidemic by identifying best practices for implementation across the country. This epidemic is complex, and the remedy won’t be simple. It will require a sustained, comprehensive approach.

Physicians have a meaningful opportunity to reduce the abuse of opioid and other prescription drugs in Arizona. Physicians can follow safe, effective and responsible prescribing practices. Here are immediate steps physicians can take to help our patient populations: 

1.  Use the Arizona Controlled Substances Prescription Monitoring Program (CSPMP). States across the U.S. have implemented prescription drug monitoring programs (PDMP). In Arizona, the CSPMP is the database used by prescribers. Arizona law requires each medical practitioner who is licensed under Title 32 and who possesses a DEA registration to also possess a current controlled substances prescription monitoring program registration issued by the Board. The registration is free and can be completed through the State Board of Pharmacy website. This registration includes: MD, DO, DDS, DMD, DPM, HMD, PA, NP, ND, OD, and DVM. Authorized persons such as DEA-registered physicians are strongly encouraged to use CSPMP. This will assist them in treating patients and in identifying and deterring drug diversion. Access and register with the CSPMP at https://www.azmd.gov/PhysicianCenter/CSPMPProgram.aspx.
 2. Discuss with patients available treatment options. When caring for patients with pain, we need to understand the best possible course for managing that pain with the tools available to us. In Arizona, the Department of Health Services convened a group of stakeholders and developed the Arizona Opioid Prescribing Guidelines. ArMA endorses this publication and encourages all physicians to make use of this vital resource. It is online here.
 3.

Take advantage of educational opportunities. Engaging in robust education activities that meet the needs of our specialties, practices and patient populations is key to delivering appropriate care for each patient. The ArMA Committee on Public Health has reviewed and identified the four courses below to recommend as CME resources for ArMA physicians. These courses are not intended to be an exclusive list, but rather they are resources that have been vetted by members of the Committee:

 - Prescription Drug Misuse and Abuse: www.vlh.com/AZPrescribing/; developed in partnership with Arizona Department of Health Services, Arizona School of Medicine, Arizona School of Public Health; two (2) hours CME, Cost = Free
 - Chronic Pain Syndromes: Current Concepts and Treatment Strategies (#98700); CME Resource, www.NetCE.com or 1-800-232-4238; 15 hours CME, Cost = $39.00
 - Treating Chronic Pain: http://www.coperems.org/; University of Washington School of Medicine, contact Mark Sullivan, MD, PhD, 206-685-3184; four (4) hours CME, Cost = Free

 - Extended-Release and Long-Acting Opioid Analgesics: ER/LA Opioid REMS Education, Informed Continuing Medical Education; 1-800-237-6999; informed.cme.edu/index.aspx; three (3) hours CME; Cost = $50.00

 4.

We have compiled the following additional resources and information to help Arizona physicians in the effort to reduce abuse of opioids in our state.

 - The CDC has released its Guideline for Prescribing Opioids for Chronic Pain. This document provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. CDC has provided a checklist for prescribing opioids for chronic pain as well as a website with additional tools to guide clinicians in implementing the recommendations.

 - Arizona Prescription Drug Misuse and Abuse Initiative: The Arizona Criminal Justice Commission and the Governor’s Office for Children, Youth and Families, along with many state and local partners, launched a multi-systemic effort to reduce prescription drug misuse and abuse in Arizona. There are resources for providers, patients, and parents.

 - Arizona Department of Health Services (ADHS) Clinical Guidelines & Recommendations – Prescribing Guidelines page is populated with information about how the guidelines were created, and with upcoming educational opportunities and current initiatives.

 - AMA’s Opioid Abuse Prevention web page offers access to education resources, and promotes comprehensive, appropriate pain treatment while safeguarding against opioid overdose. Their resources also support treating patients with substance use disorders and expanding access to naloxone.