The Corbett administration and the Pennsylvania Medical Society (PAMED) have been hard at work with several initiatives aimed at tackling the state’s prescription drug abuse crisis. One element of the joint response to this crisis was the recent adoption of voluntary prescribing guidelines for the treatment of chronic non-cancer pain
These guidelines, drafted by the state and adopted by the PAMED Board at its meeting on May 21, 2014, were announced at a joint press conference held by the state and PAMED on July 10.
They are voluntary and not intended to replace a physician’s clinical judgment. They encourage health care providers to incorporate several best practices when caring for patients receiving opioids for the treatment of chronic non-cancer pain.
“The growing epidemic of opioid abuse is one that concerns Pennsylvania physicians across the state,” said PAMED President Bruce MacLeod, MD, in a recent news release. “As an emergency physician, I see the devastating impact of prescription drug abuse on a regular basis. It’s an epidemic that does not discriminate on the basis of race, age, or gender, and no community is immune.”
Michael Ashburn, MD, MPH, MBA, director of pain medicine and palliative care at Penn Pain Medicine Center and professor of anesthesiology and critical care at the Hospital of the University of Pennsylvania, talks about the voluntary, opioid prescribing guidelines at a July 10 press conference.
Highlights of the guidelines include that providers should:
- Conduct and document a history, including documentation and verification of current medication and a physical exam, before initiating chronic opioid therapy.
- Discuss the risks and potential benefits associated with treatment with the patient so that he or she can make an informed decision regarding treatment.
- Consider initial treatment with opioids a therapeutic trial to determine whether chronic opioid therapy is appropriate for the patient.
- Individualize opioid selection, initial dosing, and dose adjustments according to the patient’s health status, previous exposure to opioids, response to treatment, and predicted or observed adverse events.
- Carefully consider if doses above 100 mg./day of oral morphine or its equivalent are indicated.
- Reassess patients on chronic opioid therapy periodically and as warranted by changing circumstances.
- Carefully monitor patients for aberrant drug-related behaviors, and consider increasing the frequency of ongoing monitoring as well as referral for specialty care, including psychological, psychiatric, and addiction experts, for patients identified to be at high risk for such behaviors.
- Carefully determine if the risk associated with chronic opioid therapy outweigh document benefit in patients who have engaged in aberrant drug-related behaviors.
- Discontinue chronic opioid therapy in patients who engage in repeated aberrant drug-related behaviors or drug abuse-diversion, experience no progress toward meeting therapeutic goals, or experience intolerable side effects.
- Understand current federal and state laws, regulatory guidelines, and policy statements that govern the use of chronic opioid therapy for chronic non-cancer pain.
Watch a video that discusses the guidelines.
These voluntary guidelines are intended to help health care providers improve patient outcomes when providing chronic opioid treatment, including avoiding potential adverse outcomes associated with the use of opioids to treat pain.
The Pennsylvania Chapter of the American College of Emergency Physicians (PaACEP), in collaboration with PAMED, also has adopted voluntary guidelines for pain treatment in the emergency department.
PAMED has been working to address opioid abuse for years, with our Pills for Ills, Not Thrills campaign, and our advocacy for the establishment of a statewide controlled substance database and medication drop-off programs.