Part B News recently talked to physicians and other experts about the opioid crisis and how practices should handle it. We also talked to a pharmacy expert and executive with some actionable ideas for managing patients on these powerful drugs.
“Best practice for dispensers is to review the PDMP [state Prescription Drug Monitoring Program] to make sure the patient hasn’t recently received another prescription” too recently, says Eric Sredzinski, Pharm.D., executive vice president for clinical affairs & quality assurance pharmacy program director for the Avella Specialty Pharmacy chain headquartered in Phoenix.
The frontline on opioids, however, remains prescribers and, while most states have PDMPs, use of them is not universally mandated; Sredzinski points to a Pew Charitable Trusts article that finds “in most states, health care professionals who prescribe at least one controlled medication are encouraged to use PDMPs, but only on a voluntary basis. As a result, the typical state program in 2012 had only 35 percent of doctors signed up for access, according to [Brandeis University’s Prescription Drug Monitoring Program Center of Excellence in Massachusetts].”
Sredzinski advocates a more conscious approach to opioid addiction. “Look at other disease states that we manage, such as cancer,” he says. “There are clear guidelines for the different kinds of cancer, based on scientific, data-driven approaches. It should be the same for opioids.” For example:
Training requirements for prescribers. Sredzinski considers opioid prescription “a subspecialty of pain management” and thinks “we may see a trend where practitioners have to go through additional training before they can prescribe opioids. Perhaps at some point, family practitioners may not to be able to prescribe them without that training.”
Follow-up standards for patient prescribed opioids. “If you see some of the doctors who got in trouble with the DEA or state boards” – such as the case of this Baltimore physician – “a lot of that revolves around inappropriate documentation of patient management,” says Sredzinski.
A defined endpoint to opioid treatment. “As with cancer patients, where at some point depending on the disease progression there’s a discussion of palliative care, there should also be a discussion as to what is the ultimate plan for the patient’s pain treatment,” says Sredzinski. “This shouldn’t be a lifelong opioid journey -- There should be an endgame to it. I would encourage a pro-active and well-documented approach.”
Join your local pain medicine society “where physicians come together and discuss the challenges they’re facing,” says Sredzinski. This is good not only for peer education, but for developing recommendations to make to regulatory and lawmaking bodies – “Otherwise it’s the lobbyists who will make all the decisions.”