Where does it hurt?

Friday, November 01, 2013 12:21 PM

Experts discuss multifaceted Rx drug abuse problem

Kate Alfano, CMS contributing writer

Earlier this year, the CMS Board of Directors voted to make the issue of prescription drug abuse a high priority. The board directed the Workers’ Compensation and Personal Injury Committee (WCPIC) to review existing CMS policies and recommend new policies to combat misuse. CMS also pledged full cooperation and support for Gov. John Hickenlooper as he and his administration developed recommendations with the National Governors Association.

A panel discussion on Saturday, Sept. 21, at the CMS Annual Meeting explored this multifaceted issue. “As has been widely mentioned through the media, Colorado is No. 2 in the country in terms of prescription drug abuse, and we physicians have a responsibility to address this serious issue,” said WCPIC Chair John Hughes, MD, the panel moderator.

“Prescription drugs are an integral treatment option for those who have serious or chronic pain, and their use has helped many people live with debilitating injuries. That being said, what happens when those drugs intended to help people get diverted or individuals begin to doctor-shop to get more, just to name a couple of scenarios? This is the problem that we are facing; many people are finding ways to game the system to get more prescription drugs and it is costing taxpayers, citizens and families. We’re here today to discuss what we can do,” Hughes added.

Hughes gave a brief overview of the prescription drug abuse platform developed by WCPIC and approved by the House of Delegates. Some of the recommendations include the following:

• A review of current evidence to understand the epidemiology of medically inappropriate use and diversion while developing strategies to address these issues;
• Development and promotion of new tools, along with existing resources and education materials that enable physicians to appropriately prescribe opioids and narcotic medications, and to avoid inappropriate prescribing;
• Development and implementation of an educational campaign;
• Partnering with other stakeholders to obtain the best defined outcomes for the Colorado Medical Society.

A distinguished group of experts served on the panel. Cynthia Coffman, JD, chief deputy attorney general in the Colorado Department of Law, presented the law enforcement perspective. Joel Dickerman, DO, member of the CMS board of directors, gave the physician perspective. Chris Gassen, RPh, PharmD, program manager for the Colorado State Board of Pharmacy, shared the pharmacy perspective. Zach Pierce, the drug policy coordinator for Gov. Hickenlooper spoke about the governor’s strategic plan to address this issue. Pierce works with policy advisor Kelly Perez, who has spearheaded these efforts over the past year.

Pierce said that one of the biggest challenges in addressing prescription drug abuse is the PDMP. “Our Prescription Drug Monitoring Program is very limited in its scope and cumbersome to use for health providers. It doesn’t allow access for office staff or others who could speed the process along and protect privacy.” Coffman also addressed the PDMP, and said that if “carefully structured,” it would meet everyone’s needs.

Pierce said physicians have a role in the governor’s vision for this epidemic: To prevent 92,000 Coloradans from misusing and abusing prescription pain medication by 2016. Physicians have already contributed greatly to the Colorado Plan to Reduce Prescription Drug abuse, which was developed through Gov. Hickenlooper’s work as chair of the National Governors Association policy academy to reduce prescription drug abuse. “Physicians know best what their patients need,” Pierce said. “They are the most reliable source of health information for their patients and they will help us to impact this problem.”

“We rely on physicians to provide us with sound clinical advice on appropriate treatment for pain,” he continued. “They can make medical education recommendations, which would include education about addiction. They can help to assure that people who need pain medication get it, and that patients are well educated about non-prescription treatments for pain.”

“I believe that CMS recognizes the great challenges physicians face in the management of pain – balancing effective pain relief with the safe prescribing of narcotic pain relievers,” added Dickerman. “CMS is working with multiple agencies to assure physicians can treat their patients effectively, and to educate patients, providers and pharmacies on the safe use of controlled medications.”