Note: Guest blogger John Gallagher, MD, is a physician who specializes in Obstetrics and Gynecology from Sharon, Pa. In addition, he is Vice Chair of the Pennsylvania Medical Society's Board of Trustees and Chair of PAMED's Opioid Advisory Task Force.
Drug-related deaths during the past 10 years are projected to surpass total U.S. deaths in the entire Vietnam War sometime in 2016. One hundred and twenty nine Americans die daily due to opiate overdosing. But, statistics fail to show the personal toll of the problem.
Physicians are faced every day with articles describing the "crisis" and how physicians have contributed to it. But, It's time to stop assigning blame. Now is the time to look forward rather than to the past. The opioid epidemic will only be controlled by concerted and coordinated changes in arenas like medicine, law enforcement, education, and the legislature. Physicians must stand up and play a leading role in this process.
The Pennsylvania Medical Society (PAMED) is striving to strategically align committed participants from varying sectors to create systems that will prevent new individuals from becoming dependent on opioids while providing recovery help to those already suffering from the disease of addiction.
Discussions with the Pennsylvania Department of Health, state legislators, district attorneys, school boards, police chiefs, and state pharmacy and dental societies are part of this collaborative approach.
I chair the Pennsylvania Medical Society's (PAMED's) Opioid Advisory Task Force. Some of our goals include:
- Development of prescribing guidelines for opiates in non-cancer chronic pain, obstetrics and gynecology, orthopedics, emergency room, with more to come. These guidelines are available at www.pamedsoc.org/OpioidGuidelines. Other guidelines, including those from the CDC, have been created. Now, we need to convince physicians to utilize these best practices to prevent inappropriate dosing and risk of dependence.
- Publicizing and expanding local drug takeback programs. Diversion of unused opiates plays a crucial role in developing and perpetuating addiction. Many counties have existing programs of which physicians and patients are currently unaware.
- Working with high schools to make naloxone available in every school.
- Assuring that naloxone is available to every police force in the state. More than 1,000 opiate deaths have been prevented since the physician general's standing order was issued, but the majority of these have occurred in a few counties. Many departments still do not have the drug available to the responding officers.
- Assisting communities in implementing the "warm handoff" where overdose survivors are placed in immediate treatment, when possible, to avoid the cycle of overdose and resuscitation.
- Lobbying for increased availability and third party funding of drug treatment programs so anyone desiring help can have immediate and regional quality care.
Many communities have the resources, but the coordination of these services is often poor. Physicians, by virtue of their central position and community prominence, can serve as local leaders in this effort. Several county medical societies are already actively engaged in this project.
PAMED has asked other counties to identify a local champion who can work with community groups to achieve this mutual goal. These grassroots leaders will be part of a statewide initiative to which PAMED will provide guidance, support, and best practices based on activities that have worked in other counties. Each county, however, will need to discover what works best based on local resources. If you are interested in serving in this role, please contact your county medical society or Deb Shoemaker at firstname.lastname@example.org.
The people who are addicted and are dying in this opioid crisis are our patients and friends and cross all socio-economic and age boundaries. As the Institute for Health Care Reform said in its report on the opioid crisis, "If you produce or prescribe opioids, if you treat addiction, if you enforce the law, if you are an educator, if you are a family member, if you're an individual taking opioids ― you have a role to play. We cannot rely on someone else to solve this crisis."
In May 2016, PAMED launched its Be Smart. Be Safe. Be Sure. initiative, which is focused on physician education and patient empowerment. Learn more, including the five-step pledge for physicians, at www.pamedsoc.org/OpioidInfo.
Access PAMED's CME series with courses on the prescribing guidelines, naloxone, referral to treatment, and the state's new prescription drug monitoring program (PDMP), at www.pamedsoc.org/OpioidsCME.