As the nation’s opioid epidemic shows little sign of abating, the AOA is actively monitoring and responding to any new legislation that has the potential to impact how osteopathic physicians address the pain needs of their patients.
Arizona and Mississippi recently introduced new legislation intended to crack down on opioid overuse.
The AOA supports a variety of approaches to addressing controlled substance misuse, abuse and diversion while trying to ensure that patients with legitimate pain care needs are able to access timely care.
“We urge a flexible, evidence-based approach that allows physicians to utilize their independent medical judgment to determine appropriate treatment,” says Raine Richards, JD, AOA director of state government affairs.
Here is a look at the new legislation and what it could mean for physicians practicing in those states and for the effort to curb the opioid crisis in the U.S.
Arizona Governor Doug Ducey pushed a bill through the Arizona legislature that caps initial opioid prescriptions at 5 days (14 for post-surgical patients) and 90-milligram morphine equivalents per day, subject to limited exceptions. If patients require a higher dose, they must consult with a pain specialist.
According to the Arizona Department of Health Services, the state had 6,749 possible opioid overdoses reported from June 15, 2017, to March 22, 2018. Forty percent of individuals were prescribed opioids two months prior to their overdose.
Michael Dekker, DO, director of addiction psychiatry for the Southwest Network, a nonprofit organization that provides behavioral health services to patients in Arizona’s Maricopa County, recently testified about the opioid crisis to the Arizona legislature.
“We want to prevent opioid dependency and still allow people to get treatment for their pain,” Dr. Dekker says. “This legislation is definitely going to make physicians think twice before prescribing opioids.”
A lack of providers in Arizona
Treatment centers and addiction medicine providers are scarce in Arizona. According to research from Pew Charitable Trusts, there are about 20 providers per 1,000 adults with substance abuse problems in Arizona. The national average is 32 providers per 1,000 adults with substance abuse problems.
One reason Dr. Dekker believes there is a shortage of providers in his state is because of the lack of addiction fellowships. Of the 104 addiction medicine and addiction psychiatry fellowships in the U.S., none train fellows in Arizona.
“Where physicians train, they usually stay there. Without an addiction fellowship here, there are not going to be a lot of treatment options,” Dr. Dekker says.
Mississippi also updated regulations that affect a physician’s ability to prescribe opioids. The AOA commented on the Mississippi Prescription Monitoring Program (MPMP) regulations, which would increase the number of physician practices defined as a “pain management practice,” subject to additional administrative requirements.
The regulations would require physicians to query the MPMP every time a controlled substance is prescribed and require additional CME. As written, the regulations also failed to appropriately recognize all pain-related subspecialty certifications offered by the AOA.
According to the CDC, Mississippi had the fourth highest opioid prescribing rates in the country in 2016.
Guidelines for chronic opioid use
The AOA also commented on the Federation of State Medical Boards’ Draft Report of the Workgroup on Prescription Drug Monitoring Programs, in support of a tailored, evidence-based approach to increase administrative requirements placed on physicians. This would avoid placing undue burdens on physicians and impede their ability to deliver timely, appropriate care.