HARRISBURG — Pennsylvania’s doctors could soon have detailed, state-approved guidelines for the prescribing of opioid pain medicines.
At Tuesday’s meeting of the state Board of Medicine, Physician General Rachel L. Levine, MD, started what could be a lengthy process toward formal approval of the guidelines — dos and don'ts for doctors, dentists, pharmacists and others involved with the dispensing of narcotic pain relievers.
The state and various organizations, including the Pennsylvania Medical Society, the Pennsylvania Dental Association and the Pennsylvania Pharmacists Association, have, in recent months, put out initial guidelines for the use of opioids in various disciplines. So far, they address use of the drugs in treating chronic non-cancer pain, emergency medicine, dentistry, geriatric pain, and obstetrics and gynecology, with more guidelines on the way.
Without the Board of Medicine’s imprimatur, though, they are little more than educational pamphlets.
Dr. Levine cited a Temple University study indicating that in states with approved prescribing guidelines, use of opioids goes down. She suggested that the board consider adopting them.
Board adoption “provides some regulating authority, some regulatory teeth, to the guidelines,” she told the board. “If we don't regulate it, other people are going to regulate it for us,” she added, a nod to the possibility of General Assembly action to write prescribing rules.
Board member Keith Loiselle questioned whether doctors were really to blame for many of the thousands of overdose deaths in the state in each recent year, or whether they stemmed from other problems, like people failing to lock up their medicines and allowing pills to fall into the hands of kids.
“So we make rules that limit how we write these prescriptions, when it’s not the people who are using them correctly that are the problem — it’s the people who are using them improperly,” said Mr. Loiselle, of Richland, who owns CDL Medical Tech, Inc.
Dr. Levine said the state's addiction problem is rooted in an increasing emphasis on reducing pain, the development of powerful and addictive opioids, and the flood of cheap heroin from Latin America. People get hooked on opioids and then drift into heroin use, she said.
“We really need to help control the amount of opioid medicine that is being prescribed,” she said after the meeting. She said that guidelines, even if endorsed by the board, wouldn’t be binding, but they would provide the state's practitioners with a set of standards to help them with decision making.
The board’s next meeting is March 15. The board handles the licensing of doctors and some other medical professionals, and also metes out discipline for violations of state code, including prescribing outside of normal practice or giving drugs to addicts. Dr. Levine said she didn’t know whether approved guidelines would factor into decisions on discipline of doctors for irregular prescribing.
Dr. Levine also told the board that the state is in the process of picking a director and a software vendor for a new system to track prescriptions, and it could be up and running within a year. Nearly every other state has such a system.