Drug abuse guidelines aimed at doctors

The prescription drug abuse epidemic sweeping Ohio led state officials Monday to announce new guidelines for doctors to help curb abuse in a state that has the 12th-highest drug overdose mortality rate in the United States, according to a new report.

The guidelines for opioid prescriptions — including powerful painkillers, such as Hydrocodone and Oxycodone — recommend that doctors and licensed clinicians reevaluate pain treatments and inform their patients about the risk of addiction and accidental overdose before prescribing opioid medication in the equivalent of 80 milligrams of morphine or more for three months or longer.

A prescription calling for a daily dose of 16 tablets of Vicodin, for example, would trigger the new guidelines, which are intended to provide a benchmark, according to Gov. John Kaisch’s Opiate Action Team, which established the guidelines in conjunction with more than 40 professional groups, state licensing boards and state agencies.

The guidelines, which have been posted on a new website — opioidprescribing.ohio.gov — are not enforceable rules or state statutes, and they do not restrict doctors from prescribing opioids above the morphine-equivalent threshold.

But the guidelines may give pause to some doctors and clinicians concerned about sanctions for over-prescribing painkillers that could lead to unintended consequences for the approximately one million Ohioans suffering from chronic pain, said Jeff Smith of the Ohio State Medical Association — the state’s largest physician organization with more than 15,000 members.

“We do expect some challenges with communicating this to physicians,” Smith said. “Patients may see a little bit of disruption across the state in terms of their pain care.”

Ohio doctors have already been hit with tough new regulations enacted in 2011 to crack down on so-called “pill mills,” or doctors’ offices and pain clinics that flood the market with pain pills.

And the new prescribing guidelines could make doctors even more gun-shy about prescribing painkillers to those patients who truly need them, said Dr. Rick Buenaventura, who practices at Pain Relief of Dayton and is a member of the Montgomery County Opiate Task Force.

“We’ve seen this before,” Buenaventura said. “And this (new guidelines) might scare doctors even more. That could mean significant difficulty in patients obtaining prescriptions for opioids needed for pain treatment.”

Still, the need for action is clear, said Helen Jones-Kelley, executive director for Montgomery County’s Alcohol, Drug Addiction and Mental Health Services.

“People die from drug overdoses daily here, so anything we can do to prevent deaths from prescription drug overdoses is a step in the right direction,” Jones-Kelley said.

Statewide, deaths from prescription opioid overdoses climbed nearly 300 percent from 199 in 2001 to 789 in 2011, according to Ohio Department of Health statistics. And an estimated five Ohioans a day die from unintentional prescription drug overdoses, which cost the state about $3.5 billion a year in medical costs, lost work time and productivity.

Nationally, Ohio is among the states where prescription drug overdose fatalities have grown most rapidly, according to the “Prescription Drug Abuse: Strategies to Stop the Epidemic” report from Trust for America’s Health —a Washington, D.C.-based nonprofit health advocacy organization.

At 16.1 deaths per 100,000 people, the number of drug overdose deaths — a majority of which are from prescription drugs — in Ohio tripled since 1999 when the rate was 4.2 per 100,000, according to the report. That ranked Ohio No. 12 among states suffering the most drug overdose fatalities, according to the report.

The report also found that Ohio ranked in the middle of the pack among states adopting strategies to help curb the epidemic.

Trust for America’s Health — in consultation with a number of public health, clinical, injury prevention, law enforcement and community organization experts — reviewed a range of national recommendations and examined a set of 10 indicators of strategies being used in states.

The report found Ohio received six out of 10 possible indicators of promising strategies to help curb prescription drug abuse. Nationally, 28 states and Washington, D.C. scored six or less, with New Mexico and Vermont scoring the highest, with a 10, and South Dakota scoring the lowest with two out of 10.

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