State group releases guidelines on opioids

Hospital association advises ERs to write limited prescriptions

Texas isn’t one of the nation’s hotbeds of opioid addiction, but concern about the ongoing crisis has caused the state’s association of hospitals to give emergency departments advice on how to curb the misuse and abuse of such painkillers.

In guidelines released Friday, the Texas Hospital Association calls on emergency departments to:

• Write prescriptions for the shortest duration possible for patients being discharged and to use only short-acting opioids.

• Consult the state’s Prescription Monitoring Program before writing opioid prescriptions.

• Put a system in place to contact the patient’s primary opioid prescriber or primary care provider to notify them of the visit and the medications prescribed.

“Texas hospitals are just one piece of the complex health care equation,” Sara Gonzalez, vice president of advocacy and public policy at the hospital association, said in a statement. “But

working with our physician and insurance partners, we believe we can start to make a difference in stemming the tide of opioid misuse and abuse.”

The association released the guidelines the same day Congress passed a two-year budget that included $6 billion to deal with the crisis — $3 billion in fiscal year 2018 and another $3 billion in fiscal year 2019. That’s in addition to existing opioidrelated funding, including the $1 billion over fiscal years 2017 and 2018 that Congress dedicated to the opioid epidemic in the 21st Century Cures Act.

The opioid epidemic has led to hundreds of thousands of drug overdose deaths since the late 1990s. A 2016 study estimated the total economic burden of prescription opioid overdose, misuse and addiction at $78.5 billion in 2013.

Texas doctors actually hand out far less addictive painkillers than most other states. Percapita opioid prescription rates in parts of the Midwest, Florida Gulf Coast, Appalachia and even the Pacific Northwest are more than double the rate recorded in Texas, according to a 2017 Centers for Disease Control and Prevention report. Another 2017 CDC report found Texas recorded fewer opioid-related hospitalizations than nearly any other state.

Still, the hospital association’s guidelines emphasized the need to minimize the inappropriate use of opioids and opioidrelated deaths in Texas.

They noted the ER prescriptions for opioids account for approximately 45 percent of opioids diverted for nonmedical use, even though such prescriptions represent just a fraction of those written nationally.

The voluntary guidelines also call for only the initial prescriber, primary care provider or specialist to write new prescriptions for controlled substances patients report lost, destroyed or stolen; the development of a process for identifying patients at risk for developing a substance use disorder or with a substance use disorder; and the development of a protocol for treating pregnant and postpartum women at risk for developing a substance use disorder or who have an active substance use disorder.