Opioids: ''Start Low and Go Very Slow''

MMS Webinar Free to All Prescribers

BY ERICA NOONAN
VITAL SIGNS STAFF WRITER

Opioid therapy should be treated with the same comprehensive, team-based approach used to successfully manage conditions such as diabetes and hypertension, according to Daniel P. Alford, M.D., director of Boston University School of Medicine’s Clinical Addiction Research and Education Unit.

He offered a set of practice guidelines to all prescribers during a recent MMS live webinar on the new Massachusetts Opioid Therapy and Physician Communication Guidelines.

“Start low and go very slow,” said Dr. Alford, describing new guidelines that call for minimum dosages, extensive documentation and assessments, and non-opioid approaches to manage chronic pain in patients.

The hour-long educational webinar, is currently available free of charge to all prescribers on the MMS website as part of the Society’s ongoing Smart and Safe opioid abuse awareness and prevention campaign.

In other developments related to the opioids epidemic:

MassBio Conference

At a policy breakfast hosted by the Massachusetts Biotechnology Council, executives from three local biotech companies — Alkermes, kaleo, and Collegium Pharmaceuticals pledged their organizations resources to help to resolve the crisis. MMS President Dennis M. Dimitri, M.D., reaffirmed the Society’s commitment to reducing excess supply of opioid medications in the community.

He added that because patients treated for chronic pain frequently have multiple co-morbidities, an integrated approach which includes behavioral health is necessary to address the underlying issues that cause patients to become addicted.

“When you integrate, you get better outcomes,” Dr. Dimitri said.

Federal Legislation

In Washington, the Massachusetts congressional delegation has led much of the federal dialogue and debate surrounding opioids and appropriate pain management. Most members have sponsored, cosponsored, or supported a federal initiative to address this public health crisis. One effort that is critical to pending state legislation would seek the DEA’s approval for state bills allowing so-called “partial fill” prescriptions.

In the U.S. Senate, Sen. Elizabeth Warren led the bipartisan effort with Sen. Edward Markey and three other senators, sending a letter to the DEA in late December requesting guidance on the development of a new rule to make clear to states that the partial filling of prescriptions for Schedule II drugs is permitted under federal law.

In the U.S. House of Representatives, Rep. Katherine Clark sponsored a bipartisan letter signed by 47 members of the House — including every member of the Massachusetts congressional delegation — seeking clarification of the DEA rules.

If approved, states would be allowed to pass laws to allow patients to partially fill their prescriptions.

The MMS is in strong support of facilitating partial fill options for opioid prescriptions. It is important to underscore that the Society’s opioid prescribing guidelines, which were adopted for use last year by the Mass. Board of Registration in Medicine, recommend that “the starting dose should be the minimum necessary to achieve the desired level of pain control and to avoid excessive side effects.”

The MMS believes that this policy could contribute to a significant reduction in unused pills in medicine cabinets available for misuse and diversion while allowing patients who are in pain to receive necessary medication appropriately.

Passage of federal legislation to address the many aspects of the opioid crisis is one of the main congressional health care priorities for the spring. The MMS will continue to work closely with the members of the Massachusetts congressional delegation on a variety of initiatives to address this public health crisis.

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