Pre­scrip­tions for painkillers de­clin­ing

Northwest Arkansas Democrat-Gazette - - NORTHWEST ARKANSAS - ANDY DAVIS

The num­ber of drug over­dose deaths in Arkansas in­creased slightly last year, while the num­ber of pre­scrip­tions for opi­oid pain med­i­ca­tion fell, state De­part­ment of Health of­fi­cials said Mon­day.

Ac­cord­ing to the de­part­ment, 384 Arkansans died of drug over­doses in 2016, com­pared with 383 in 2015.

Over the same pe­riod, the num­ber of pre­scrip­tions filled for opi­oid med­i­ca­tions fell by about 50,000, to 3.6 mil­lion in 2016, Health

De­part­ment Di­rec­tor Nate Smith told state leg­is­la­tors dur­ing a com­mit­tee meet­ing Mon­day.

In 2014, about 3.7 mil­lion opi­oid pre­scrip­tions were filled.

The num­ber of pills dis­pensed also fell, from 242 mil­lion in 2015 to 235 mil­lion last year, he said.

“I think we’re start­ing to make an im­pact,” Smith said of ef­forts to re­duce the pre­scrib­ing of ad­dic­tive painkillers and shut down il­le­gal sources of the med­i­ca­tions.

The num­ber of drug deaths in the state each year “seems to be plateau­ing off,” al­though it re­mains high com­pared with the early 2000s, he said.

Smith gave law­mak­ers an up­date on opi­oid use in the state dur­ing a joint meet­ing of the Leg­is­la­ture’s Public Health, Wel­fare and La­bor and Agri­cul­ture, Forestry and Eco­nomic De­vel­op­ment com­mit­tees.

He cred­ited the state’s Pre­scrip­tion Mon­i­tor­ing Pro­gram, law en­force­ment ef­forts

to shut down “pill mills” that of­fered pre­scrip­tions for cash, and pre­scrib­ing guide­lines is­sued by the U.S. Cen­ters for Disease Con­trol and Pre­ven­tion last year with help­ing to re­duce opi­oid use in the state.

But he noted, “We do have a lot of Arkansans who are de­pen­dent on opi­ates.”

“They need to be weaned down,” he said. “They can’t be stopped abruptly.”

At one time, Smith said, opi­oids were used pri­mar­ily to treat acute pain, such as af­ter a surgery, or to re­lieve the pain from a ter­mi­nal ill­ness.

In the late 1990s, doc­tors be­gan pre­scrib­ing opi­oids to treat chronic pain, lead­ing pa­tients to be­come de­pen­dent on the drugs, he said.

Opi­oids are drugs such as hy­drocodone, codeine, mor­phine and oth­ers that act on the hu­man ner­vous sys­tem to re­lieve pain. Some opi­oids are syn­thetic and oth­ers are de­rived from opium.

The CDC guide­lines rec­om­mend that doc­tors try other meth­ods for man­ag­ing chronic pain and con­sider opi­oids “only if ex­pected ben­e­fits for both pain and func­tion are ex­pected to out­weigh risks to the pa­tient.”

Na­tion­wide, the CDC re­ported last week, opi­oid pre­scrip­tions per per­son peaked in 2010 and fell 13 per­cent from 2010 to 2015.

Es­tab­lished in 2013, the state’s Pre­scrip­tion Mon­i­tor­ing Pro­gram col­lects in­for­ma­tion from phar­ma­cies on pre­scrip­tions for pain med­i­ca­tion and other fre­quently abused drugs.

Act 820, passed by the Leg­is­la­ture this year, re­quires doc­tors to check the pro­gram’s data­base be­fore pre­scrib­ing such med­i­ca­tions, un­less the drug is pre­scribed be­fore or af­ter surgery, for a ter­mi­nal ill­ness or to a nurs­ing home res­i­dent.

The law also re­quires the Health De­part­ment to use in­for­ma­tion from the data­base to iden­tify pa­tients who ap­pear to be mis­us­ing the drugs and pro­vide the in­for­ma­tion in quar­terly re­ports to doc­tors and phar­ma­cists.

Denise Robertson, the pro­gram’s ad­min­is­tra­tor, said she ex­pects the first re­ports to go out early next year.

Act 820 also calls on the state boards that li­cense doc­tors, phar­ma­cists, nurses, den­tists, op­tometrists and ve­teri­nar­i­ans to de­velop rules

lim­it­ing the amount of opi­oids that can be pre­scribed or dis­pensed to pa­tients.

Smith said the data­base al­ready ap­pears to have helped re­duce “doc­tor shop­ping” among pa­tients.

Dur­ing the first three months of 2015, the de­part­ment counted 40 pa­tients who had seen seven or more physi­cians and vis­ited seven more phar­ma­cies dur­ing a 90day pe­riod.

Dur­ing the last three months of last year, the de­part­ment counted only 20 such pa­tients, he said.

Rep. Deb­o­rah Fer­gu­son, D-West Mem­phis, said plac­ing too many re­stric­tions on opi­oids could lead pa­tients to turn to il­le­gal sources.

Asked by Fer­gu­son whether the state has enough treat­ment op­tions for ad­dicts, Smith re­sponded, “I would re­ally ques­tion whether our cur­rent treat­ment ser­vices for opi­ate de­pen­dents are ad­e­quate to treat all of those who need it.”

“Get­ting our med­i­cal com­mu­nity, our be­hav­ioral health com­mu­nity ramped up and fully en­gaged is go­ing to be a big pri­or­ity,” he said.

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