Ohio Launches Opioid Prescribing Education Initiative
Guidelines Stress Reevaluation at 80 milligrams MED
New Website: www.opioidprescribing.ohio.gov
CME Video: www.med.ohio.gov/webhost/OOAT_CME.html
Rx Prescribing Guidelines Fact Sheet: http://1.usa.gov/GJnEfg
Gov. Kasich's Press Release: http://1.usa.gov/1gjThsX
Chronic Pain: A Regional Collaboration Symposium - December 14 in Chillicothe: http://bit.ly/GJhdYt
As part of an ongoing effort to curb the misuse and abuse of prescription pain medications and unintentional overdoses, Gov. John R. Kasich announced the adoption of new opioid prescribing guidelines and launch of a new website. The guidelines were developed by the Governor’s Cabinet Opiate Action Team (GCOAT)--which included OOA representatives and several DOs--along with other professional groups, state licensing board and state agencies.
In conjunction with the announcement, OOA Executive Director Jon F. Wills and Cleanne Cass, DO, of Dayton, participated in a media call, Oct. 7, with 40+ reporters and public health officials to answer questions. Other officials making statements included State Health Director Ted Wymyslo, MD, Ohio Director of Aging Bonnie Kantor-Berman; GCOAT Director Orman Hall; and representatives from state state agencies that license Ohio's prescribers.
Guidelines Set 80 milligram MED Trigger
The new guidelines recommend that 80 milligrams Morphine Equivalent Daily Dose (MED) should trigger the prescriber to “press pause” and reevaluate the effectiveness and safety of the patient’s pain management plan. The guidelines are intended to supplement, and not replace, the prescriber’s clinical judgment.
The guidelines also strongly advise prescribers to talk with their patients about managing their chronic pain, the risks of an unintentional overdose from their prescription pain medication, the potential for pain medication abuse, and secure storage of their pain medications to prevent misuse by others.
"Research shows that patients who receive higher doses of prescribed pain medications are at increased risk for overdose and need close supervision and periodic reevaluation," Wills said. "Statistics also show that five Ohioans lose their lives every day due to prescription drug abuse. Like any public health emergency, the solution requires education, teamwork, and action."
Multi-modal Treatment Plans Encouraged
"Part of the evaluation we’re encouraging along with these guidelines is working toward what we call a multi-modal plan," Cass said. "That means treating pain could include prescription opioids, but it should not be the only part of the plan. The answer to under treatment of pain is to not default automatically to opiates in all cases. We need to make sure that we’re using medications appropriately in an appropriately-chosen patient."
Cass said the guidelines recommend that physicians treating chronic, non-terminal pain patients who have received opioids equal to or greater than 80 milligrams MED for longer than three months should take steps to help keep patients safe. "This includes providing the patient with written information that documents the risks; going down the checklist of things like: can the patient function and manage daily living activities; are there any signs of addiction," she said. "We’re also encouraging the prescribers to develop and implement a patient pain treatment agreement. In that agreement prescribers can ask for things like more frequent office visits, different treatment options, drug screens or the use of one pharmacy."
All Physicians Should Register For OARRS, View Video
OARRS, the Ohio Automated Rx Reporting System, is another important tool for prescribers. The new guidelines encourage prescribers to use the data in OARRS so that they will know how much pain medication a patient already is receiving, perhaps from multiple prescribers. A new OARRS tool launched with these prescribing guidelines assists prescribers by calculating a patient’s opioid prescriptions into a single MED score for comparison to the 80 MED threshold.
The new prescriber-focused website – www.opioidprescribing.ohio.gov – includes resources prescribers can use to incorporate the guidelines into their daily practice, a continuing education video module, a toolkit, and patient resources. The video features Michael Bourn, DO, of Columbus, as the main clinical presenter. State Rep. Terry Johnson, DO, also appears in the video.
DOs can receive one hour of AOA Category I-B credit or one hour of Osteopathic Category 1-C credit certified by the Ohio Osteopathic Association and approved by the Medical Board for licensure purposes by viewing the video and successfully answering the post viewing test questions.
The guidelines for all opioid prescribers build upon the Kasich Administration’s ongoing efforts to fight prescription drug abuse. In 2011, Gov. Kasich signed House Bill 93 to shut down “pill mills.” In 2012, the Administration adopted prescribing guidelines for emergency departments and acute care facilities. Thus far in 2013, the Ohio State Highway Patrol has seized nearly 50 percent more pills than the 2010-2012 average.
In addition to Wills, Cass, Bourn, and Johnson, other DOs working on the GCOAT project are Aaron Adams, DO, of Portsmouth, and Maury L. Witkoff, DO, of Columbus.