Pubdate: Fri, 30 Dec 2016
Source: Pittsburgh Post-Gazette (PA)
Copyright: 2016 PG Publishing Co., Inc.
Author: Rich Lord


Pa. Physician General Dr. Rachel Levine during a meeting with the staff of
the Twin Lakes treatment facility near Somerset for people suffering with
alcohol and substance abuse.

Pennsylvania's avalanche of opioids that rolled from factories through
pharmacies to medicine cabinets, and then tumbled into the streets with
tragic results, may finally be slowing thanks to pressure on the
prescribing practices of its doctors.

This year, the long-lagging state caught up with the regulatory steps of
many of its neighbors, as Gov. Tom Wolf and legislators from
overdose-plagued districts wrote new laws. Initial data suggests that
attention to the overprescribing of opioids - widely blamed for starting
addictions that progress to heroin use - has started to affect doctors'

"I think that our message is getting out, and I think there is the
beginning of a change in prescribing culture," said state Physician
General Rachel Levine. "There is evidence that there has been, both in
Pennsylvania and nationally, less prescribing for opioids by physicians
and other health care providers."

Highmark shared data showing that the number of prescriptions for opioids
it reimbursed in each of the past three months was lower than in any of
the prior nine months. UPMC Health Plan would not provide detailed data or
an interview, but wrote that 16 percent of its insured population received
at least one opioid prescription this year, down from 20 percent in 2015.

Highmark is working to identify and treat patients with conditions like
depression, which can lead to prescription abuse and illicit drug use,
said Dr. Charles DeShazer, the insurer's vice president and executive
medical director for clinical services. And in West Virginia, the insurer
has hired Axial Healthcare to comb its data for indications of
overprescribing, so that it can "discuss with [doctors] appropriate
behaviors and prescribing guidelines," he said. If it works, Highmark may
expand that effort to Pennsylvania.

UPMC Health Plan indicated it is using "an algorithm to identify patients
who may be at risk for opioid addiction," and training doctors to use
other pain management tools.

If the experiences of Highmark and UPMC are any indication, this year
might mark a turning point following more than a decade of stubbornly
rising opioid prescribing that continued through 2015. The Drug
Enforcement Administration reported last week that more than 3.7 million
prescriptions were filled by Pennsylvania pharmacies for 283 million
oxycodone pills, up 3.8 percent from the prior year.

In the eastern half of the state, federal prosecutors working with the DEA
and FBI have continued to criminally charge high-prescribing physicians.
Former Philadelphia physician Jeffrey Bado, who had vigorously defended
his opioid prescribing, was found guilty this month of 308 federal felony
counts, including one count of drug distribution resulting in death. He
faces sentencing in March.

Spurred largely by such prosecutions, the state Board of Medicine and
Board of Osteopathic Medicine this year acted against the licenses of at
least 18 Pennsylvania doctors accused of overprescribing narcotics. From
2011 through 2015, those boards totaled just 53 such actions, fewer than
11 a year, a rate far lower than that of numerous other states.

ned for their narcotics prescribing practices in seven Appalachian states,
of which Pennsylvania had taken the fewest measures to rein in rogue

In October, the General Assembly passed, and Mr. Wolf signed, laws that
could lead to more disciplinary actions should doctors wantonly prescribe

* Doctors can no longer prescribe more than a week's worth of opioids to
minors, unless they thoroughly document the need.

* Effective next week, emergency medicine practitioners will also be
largely restricted to prescribing a week's supply of opioids.

* Also in 2017, medical schools will have to include proper narcotics
prescribing in the curriculum.

* Doctors will be required to take biennial refresher courses in
painkiller practices.

* Practitioners planning to prescribe opioids or benzodiazepine
tranquilizers will have to first check the patient's drug history using an
online database.

If that database shows that the patient is getting prescriptions from
multiple sources - called "doctor shopping" - the physician can refer them
to rehab. That database, though, doesn't yet connect to similar programs
in neighboring states, so abusers or pill pushers might be able to get
drugs via multiple physicians by crossing borders. Dr. Levine said the
state intends to link its database to those of its neighbors, but has no
timeline for doing so.

Experts are not predicting any quick reversal of the surge of heroin and
fentanyl that, along with prescription narcotics, was implicated in 81
percent of the state's 3,383 fatal overdoses last year.

"The pills still supply a feeder system to the heroin epidemic," said Gary
Tuggle, special agent in charge of the DEA for Pennsylvania. "It's still
an issue, and it's always going to be an issue, until we can get a handle
on overprescribing, diversion and doctor shopping.

"Hopefully," said Mr. Tuggle, "gone are the days of just mass prescribing."
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