Pubdate: Fri, 22 May 2015
Source: Boston Globe (MA)
Copyright: 2015 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Felice J. Freyer

OPIOID GUIDANCE OFFERED TO DOCTORS

The Massachusetts Medical Society released opioid-prescribing 
guidelines Thursday intended to help physicians make sure patients in 
pain get the correct treatment without contributing to the epidemic 
of opioid abuse.

"Most physicians do prescribe quite responsibly," said Dr. Dennis M. 
Dimitri, president of the statewide physicians association, which has 
nearly 25,000 members. "We realize sometimes overprescribing can be a problem."

The medical society also has started offering its online and 
in-person pain-management courses free of charge to doctors and other 
health professionals (nonmembers had paid $11 to $132, while members 
paid about half that).

In addition, the association said it intends to work with the 
Partnership for Drug-Free Kids to educate patients about proper 
storage and disposal of medications.

Dimitri said painkiller abuse often involves people to whom the drugs 
were not prescribed. He cited statistics from the US Centers for 
Disease Control and Prevention showing that more than 80 percent of 
people who misuse prescription pain medications are using drugs 
prescribed to someone else.

Opioid abuse considered widespread, poll finds

Mass. residents are more worried about drug abuse than are Americans 
generally, a Boston Globe poll found.

But he acknowledged the data make clear "that there are too many 
doses of opioid medications in circulation." The medical society's 
goal, he said, is to ensure opioids are limited to those truly needing them.

The guidelines, developed by a task force of physicians from several 
specialties, are to be used by physicians in combination with their 
clinical judgment.

'Pain is a complex symptom that can be related to many different factors.'

They advise physicians on how to start patients on opioid treatment, 
including checking if patients have a history of substance abuse and 
informing them of the drugs' risks.

The recommendations also are designed to help doctors determine if 
treatment beyond 60 days is warranted, and to guide them in managing 
chronic pain, including regular monitoring and making treatment-plan 
agreements with patients.

Dimitri, a family practice doctor in Worcester, said that he often 
sees patients with chronic pain and finds it a challenge.

"Pain is a complex symptom that can be related to many different 
factors," he said. In addition to the physiological issues, pain is 
strongly influenced by emotion and lifestyle.

"Teasing that all out and trying to figure out the best way of 
treating goes far beyond deciding whether you want to prescribe 
opioids," Dimitri said.

The medical association's announcement came amid other public 
pronouncements this week about opioid-related overdoses that claimed 
the lives of more than 1,000 Massachusetts residents last year and 
that continue to command the attention of policy makers.

On Monday, Governor Charlie Baker expressed surprise that only 36 
percent of Massachusetts adults said, in a poll published Sunday, 
that they had been warned by doctors of the addictive risks of 
prescription painkillers.

Asked about the governor's comments, Dimitri said: "Physicians 
routinely talk to patients about the risk and benefits of every drug. 
It's pretty much standard practice."

The survey by The Boston Globe and the Harvard T.H. Chan School of 
Public Health also found that nearly three-quarters of Massachusetts 
adults believe heroin use is an extreme or very serious problem in the state.

Also this week:

Mayor Martin J. Walsh on Wednesday released a report on substance 
abuse and addiction in the city and announced that Jennifer Tracey, 
previously director of the Office of Youth and Young Adult Services 
at the state Bureau of Substance Abuse Services, will head the 
mayor's Office of Recovery Services. The mayor's 2015 budget set 
aside $300,000 to support the office's creation.

Dr. Monica Bharel, the state public health commissioner, spoke 
Thursday before a US House energy and commerce subcommittee about the 
state's efforts to address the opioid abuse epidemic.

"We are watching our friends and family members die on our streets, 
driven by a lethal cocktail of trauma and underlying behavioral 
health issues," Bharel said, according to a transcript of her talk. 
"That is not something we, as a society, should accept as a norm."
- ---
MAP posted-by: Jay Bergstrom