Plan helps doctors check painkiller use

Abuse statistics draw attention

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Small white pills, packaged in bright orange canisters and marked with inscrutable labels -- Oxycontin, Vicodin -- have long been considered the answer to physical pain.

Now, as the fight against painkiller abuse gains traction in Pennsylvania, state officials and medical agencies are coming together to curb the region's high rates of drug overdose and addiction through a series of voluntary prescribing guidelines for physicians. In collaboration with 70 organizations, Gov. Tom Corbett'‍s office released the first of these documents last week, outlining recommendations for prescribing opioids to treat chronic non-cancer pain.

"We want to move away from the attitude of 'Let's just prescribe you Vicodin and consider our job done,' ‍" said Gary Tennis, the state secretary of drug and alcohol programs, who is co-chairman of the task force behind the guidelines. "Pain management is a multimodal operation."

Commonly known as narcotics, opioid medications are used to soothe pain stemming from conditions such as back injuries, broken limbs or arthritis. A study the Centers for Disease Control and Prevention released July 4 found that Pennsylvania ranked above the national average prescribing rate for all painkiller types measured, with 88.2 opioid prescriptions for every 100 individuals.

Patients who build tolerance for these prescription drugs are vulnerable to addiction to more dangerous substances such as heroin. Pennsylvania rose to seventh place in the nation in drug-related deaths this year, according to the National Center for Health Statistics.

Carrie DeLone, Pennsylvania's physician general and another task force leader, emphasized that the guidelines' goal is not to decrease treatment for those in need but rather to "ensure that we're treating them in as safe a method as possible."

She said the recommendations will empower doctors to broach otherwise sensitive subjects with their patients, such as whether a patient has a history of drug abuse.

"As a physician, sometimes you get a feeling that the drugs are being misused, because patients will tell you they lost the medication or they washed it in a laundry machine," Ms. DeLone said. "These guidelines make those difficult questions easier to ask; patients will be more understanding if this is the standard of care."

Among the suggestions listed in the three-page document are recommendations for alternative methods of pain treatment such as physical therapy and psychotherapy and consideration for a patient's history of drug-related behavior. The guidelines can be accessed on the Pennsylvania Medical Society's website (pamedsoc.org/opioidguidelines).

The society played a major role in establishing the recommendations, as the organization was already working on them when Mr. Corbett formed his task force, said Pennsylvania Medical Society president Bruce MacLeod, who also is the chairman of West Penn Hospital's emergency department. The group is working with the Allegheny County Medical Society to propagate the guidelines through newsletters and other notices statewide.

While the Pennsylvania Pharmacists Association will likely give its endorsement, chief executive officer Patricia Epple said it was not approached with the guidelines until June 26, when the process was already in its final stages.

"There wasn't really time to review it before it was printed," Ms. Epple said. "As the dispensers, pharmacists are the ones who see what's really going on in the marketplace, so it would have been nice to be involved as a stakeholder."

Pittsburgh-area doctors said while the guidelines are a step forward, they can't replace the need for a statewide prescription-monitoring database. After passage of a state Senate bill and a state House bill that would allow physicians to see whether patients are receiving pain medication from multiple prescribers, work began on a combined bill for Mr. Corbett's review.

"The balance to be struck in ensuring adequate treatment of patients' pain and minimizing patients' divergence to abuse is not one that can be easily legislated through guidelines or any universal approach," said Michael Lynch, medical director of the Pittsburgh Poison Center.

The task force plans to release opioid prescription guidelines for acute care and dental care in the coming months.


Yanan Wang: ywang@post-gazette.com, 412-263-1949 or on Twitter @yananw.

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