By Wayne Allen
October 8, 2013
PDT Staff Writer
On Monday officials with the state of Ohio announced new opioid prescribing guidelines aimed at preventing abuse and saving lives.
According to John Wills of the Ohio Osteopathic Association, “Statistics show five Ohioans are losing their lives to prescription drug abuse everyday, and drug abuse deaths have truly reached an epidemic level. Like any public health emergency the solution requires education, teamwork and action.”
Wills said, the estimated cost of drug abuse in the state of Ohio is $3.5 billion a year and is the leading cause of injury-death surpassing motor vehicle deaths.
“To solve this problem we need to have a patient, physician partnership. Patients need to ensure their medications are being used properly, stored securely and never shared with other individuals,” Wills said.
Theodore E. Wymyslo, M.D., Director, Ohio Department of Health said the new guidelines, “Are intended to help, prescribers review and assess their approach in prescribing opioids for chronic non-cancer pain. We’re recommending that before a patient receives a daily dose of prescription pain medication equalling 80 milligrams of morphine, prescribers should pause and reevaluate that patients pain management plan.”
According to released information, the new guidelines were developed by the Governor’s Cabinet Opiate Action Team (GCOAT) and in conjunction with more than 40 professional groups, state licensing boards and state agencies.
“The 80 milligram morphine equivalent dose recommendation takes into consideration all prescription pain medications a patient is taking that would, together add up to 80 milligrams or more of morphine everyday,” Wymyslo said. “Why did we pick 80 milligram morphine equivalent dose? Through research the Governor’s Cabinet Opiate Action Team found out that the risk for overdose increases in direct proportion with an increased daily dose of an opioid. Specifically, we found that unintentional overdosing on prescription pain medications happen most frequently in those patients who are taking 50 - 99 milligrams morphine equivalent dose.”
He said the odds of unintentional overdoses at an 80 milligram morphine equivalent are three times higher than patients who are treated with doses under the equivalent of 50 milligrams of morphine everyday.
“When the dose is greater than the equivalent of 100 milligrams of morphine daily, the chances of overdose are 11 times greater,” Wymyslo said. “We also had to face the reality that up to 50 percent of patients using chronic opioid therapy for chronic non-cancer pain misuse their medication.”
Jeff Smith of the Ohio Medical Association said one the goals of the new guidelines was to get prescribers to utilize the Ohio Automated Rx Reporting System (OARRS) to it’s fullest extent.
“OARRS, is an important clinical tool that provides information on who’s writing prescriptions, as well as how much medication the patients are filling as well as where and when they are filling it,” Smith said. “The report (from OARRS) can also give you a total cumulative morphine equivalent for the patients total prescriptions. Our goal with this initiative is to get 100 percent of Ohio’s DEA (Drug Enforcement Agency) licensed prescribers to register and utilize the OARRS database.”
Smith said in addition to the OARRS database the Ohio State Medical Association has created training and resources for physicians to provide the highest quality of care.
When asked how these new guidelines will impact those who need more than an 80 milligram morphine equivalent everyday dosage to still receive it, Smith said, “It is a concern in the medical community. We think a collaborative approach to establishing these guidelines for a standard of care in the state of Ohio is a much better approach than taking a punitive approach. We do expect there is going to be some challenges in communicating this information to the medical community and patients may see a little bit of a disruption in terms of their pain care. You can count on the 44 organizations that are involved in this initiative to ensure that accurate information is provided to the medical community and that patients are not displaced. If they are displaced it is temporary and we are going to do everything in our power to make sure that patients continue to get appropriate access to the best pain care in the state and that’s what these guidelines do.”
According to released information from Gov. John Kasich’s office, “These guidelines for all opioid prescribers build upon the Kasich Administration’s ongoing efforts to fight prescription drug abuse. In 2011, Gov. Kasich signed House Bill 93 to shutdown ‘pill mills.’ In 2012, the administration adopted prescribing guidelines for emergency departments and acute care facilities. Thus far in 2013, the Ohio State Highway Patrol has seized 50 percent more pills than the 2010-2012 average.”
Wayne Allen may be reached at 740-353-3101, ext. 228, or firstname.lastname@example.org. For breaking news, follow Wayne on Twitter @WayneallenPDT.