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Efforts escalate to curb inappropriate prescribing
e-Reports, Dec. 17, 2012
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"Since January, the Attorney General’s Office has filed numerous licensing actions against physicians for overprescribing with several cases involving deaths resulting from the over prescribing."

Office of the Indiana Attorney General, Dec. 3, 2012

An epidemic of pain medication abuse exists in Indiana and the nation. Every physician has a role to play in stemming the tide of this epidemic to save lives.

Dr. Fishman
Scott Fishman, M.D., leads the “Responsible Pain Management Prescribing” webcast. Hundreds of physicians participated.

“Clinical practice must change,” said Scott Fishman, M.D., a leading pain management expert, chief of the Division of Pain Medicine and professor of Anesthesiology at the University of California, Davis. “All medical decisions are based on weighing benefits against risks. In the case of using opioids for chronic pain, the scientific literature has been either weak or inadequate regarding long-term benefits. What we do know is that the emerging risk data over the past five or six years clearly show us that we must be extremely careful with these drugs.”

Dr. Fishman wrote “Responsible Opioid Prescribing: A Clinician’s Guide, Second Edition,” and presented a Dec. 7 CME session for the ISMA.* That session was held one day after the Medical Licensing Board of Indiana (MLB) summarily suspended the licenses of two physicians because of their controlled substance prescribing practices.

Lea Marlow, M.D., a family medicine physician practicing at a pain center in Jeffersonville, was cited by the attorney general’s office as having prescribed “more than 8,000 prescriptions for 3,489 patients – with more than 95 percent receiving oxycodone.” Dr. Marlow had no formal pain management education or fellowship training, according to testimony.

William Hedrick, M.D., from a Fort Wayne pain center, agreed to an emergency suspension of his license until the Jan. 24 MLB meeting when a full hearing will be conducted. The attorney general’s office wrote in a complaint, “numerous patients have died from multiple drug toxicity while in Hedrick’s care and these types of aggressive prescription practices are dangerous.”

Expectations changing
While pain is the most common reason patients visit a doctor, it is not addressed in medical school, Dr. Fishman said. “We don’t educate physicians on the use of controlled substances, pain and pain management. This must be reversed.”

He recommended physicians have established policies and procedures for controlled substance prescribing, as well as a plan that includes an exit plan. The patient should read and sign the plan, and the physician should look at outcomes of therapy, adverse effects and the patient’s ability to function.

Timothy King, M.D., an ISMA member from northwest Indiana who is board certified in Pain Management, said, “Dr. Fishman is correct. Every physician in the state – whether practicing formal pain management or not – should attend the webinar and review his book on prescribing controlled substances.” Buy the book here.

Laws and regulation coming
Both the ISMA and the state have created task forces to address controlled substance prescribing and addiction issues. The ISMA’s Ad Hoc Task Force on Pain Management resulted from adopted Resolution 12-23. It’s purpose is “to study and advise” about trends related to legislative and regulatory agendas on pain management.

Prescribed substancesThe attorney general’s office formed the Prescription Drug Task Force to review the need for legislation to educate prescribers and heighten awareness of the epidemic of prescription drug abuse.

“We understand that legislation is being considered, and we want to help ensure a balance is struck that encourages physicians to follow best practices while avoiding a statue that is overly prescriptive, as recently occurred in Kentucky and Ohio,” said Mike Rinebold, director of Government Relations, who sits on a subcommittee of the state task force.

“The attorney general’s office formed this task force to respond at the highest level,” said Rinebold. “The five subcommittees include experts across all stakeholder audiences who are working for a comprehensive statewide solution to protect Hoosiers.”

ISMA Reports will continue to cover this issue, especially as the 2013 Indiana General Assembly convenes.

*Dr. Fishman’s presentation will be available online, on-demand soon; ISMA Reports will alert you when it becomes available, or periodically check www.ismanet.org.

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