The Opioid Crisis in the United States continues to rage on. According to recent figures, there were almost 70,000 opioid related overdose deaths in the United States in 2020, stemming from prescription pain relievers, heroin and other synthetics such as fentanyl. This is an increase of 5% from 2019.
Pennsylvanians have experienced first-hand the negative impact of the opioid epidemic on their communities, and in 2020 alone, almost 5,000 deaths involved opioids. With improved Pennsylvania Opioid Dispensing Guidelines in place, the state has taken significant steps to help providers enhance their prescribing practices -- but how do these changes impact providers on a practical level? Let’s take a deeper look.
Over the last five years, the National Institutes of Health (NIH) have opened and encouraged dialog between pharma companies and research centers, challenging the industry on how to manage chronic pain safely. They’ve also developed new and innovative medications to treat opioid use disorders and have invested in improved overdose prevention and other interventions to save lives.
With opioids at the heart of national discourse, many states are refining their opioid prescribing guidelines.
In the State of Pennsylvania, regulations exist for the prescription and monitoring of opioids. The Pennsylvania Prescription Drug Monitoring Program (PA PDMP) collects information on all filled prescriptions for controlled substances and prescribers must register with the PDMP.
Through this program, prescribers must query the PDMP the first time a controlled substance is prescribed. If abuse or diversion is suspected, a query must also then follow.
Pennsylvania’s naloxone access law allows prescribers to issue a prescription to a person at risk of experiencing an opioid-related overdose or issue a prescription to a family member, friend or another person in a position to assist said person at risk.
While Pennsylvania doesn’t have a pain clinic registration act nor a pain management registration requirement, the state has codified prescribing guidelines for emergency department or urgent care centers in the Safe Emergency Prescribing Act (35 PA. Cons. Stat. § 873.1et seq.).
In summary, this act limits prescriptions in an emergency department or urgent care centers to a 7-day supply with exceptions, via the lowest effective dose for the shortest duration possible.
Pennsylvania code 49 § 16.92 provides the Board of Medicine’s Minimum Standards of Practice, requiring prescribers to conduct an initial medical history and physical evaluation, as well as patient counseling. The guidelines recommend drug testing prior to beginning opioid therapy, especially in conjunction with other treatments.
They also recommend periodic urine drug screens that are completed annually at minimum, as well as urine or saliva drug testing and pill count monitoring.
Pennsylvania does not have guidance on the treatment of opioid addiction in the medical office, and as part of prescribing guidelines, recommendations simply state to conduct drug screens prior to administration of such drugs. In February of 2019, Senate Bill 191 was introduced as an amendment to Title 35 to provide for office-based opioid and non-narcotic opioid treatment certification, and to establish the Opioid Treatment Certification Fund. Unfortunately, this bill failed in December of 2020.
However as a result of the COVID-19 pandemic, a regulatory waiver allowed buprenorphine treatment via telemedicine for opioid use disorder, thus exempting in-person physical examinations prior to treatment.
Many providers have a deep sense of duty to do right by their patients. After all, helping people is generally what attracts people to healthcare as a profession. While an increase in prescribing guidelines can seem overwhelming, following best practices is often the most responsible thing a provider can do to protect their patients from the risks of misusing prescription opioids.
If a patient fatally overdoses on an opioid prescribed by a provider, there will be an investigation. Some of the negative consequences of an investigation where it’s found the provider missed the mark with their opioid prescribing practices include the risk of the provider losing their good reputation among peers and patients, as well as legal liability and even the loss of a provider’s license.
Utilizing procedures that are accepted or advised as being correct or most effective as best practices are one of the top ways to maintain a high level of patient care when prescribing opioids while also mitigating liability as a provider.
When it comes to the five best practices listed above, one practice is clearly the most objective and scientific way to monitor and prevent opioid misuse. Toxicology screening is the only measure of what a patient actually took, of what is actually in their body — it is not an estimation based on what they have left or if they received multiple prescriptions from other doctors. To put it simply, toxicology testing matters.
At DRUGSCAN, we pride ourselves on taking a proactive approach to help providers in large institutions and smaller private offices alike with the tools necessary to safely distribute and monitor the delivery of opioids. While remaining flexible and nimble with drug monitoring programs and addiction management protocols, we are able to work within each State's guidelines, regardless of presented complexities.
Think of DRUGSCAN as an extension of your patient care team and a strategic partner that demystifies regulations and provider liability, saving you precious time and administration while helping you better care for your patients.
Whether you’re a private physician or working in a medical practice within a large hospital system, DRUGSCAN offers you testing services and helps you make critical decisions regarding your patients, quickly and efficiently.