In the U.S., 259 million prescriptions were written in 2012 for pain medications, and 99 percent of the world’s use of hydrocodone was here in our nation. In addition, diagnoses of Neonatal Abstinence Syndrome increased three-fold from 2002 to 2009.
This epidemic resulted in drug overdose deaths overtaking auto accidents as the number one cause of accidental death in 2012 – with about 1,000 of those deaths occurring in Indiana.
In the months that followed, a call for action brought together physicians, legislators, the Medical Licensing Board (MLB) of Indiana and Indiana Attorney General Gregory Zoeller to combat the problem. The result is a final version of the opioid prescribing rule for chronic pain management issued by the MLB that became effective Nov. 6, 2014. Find it here.
The final rule gives clear guidance to physicians about INSPECT, drug testing and informed consent. It includes warnings for women of child-bearing age about the effects of opioids on newborn infants and about provision of written warnings when prescribing hydrocodone-only extended release medication not in an abuse-deterrent form.
With temporary rules in place over the past year, physicians have learned to use the tools available to assure patients receive appropriate relief of chronic pain by following the best evidence-based treatments available. Physicians are also helping to identify patients with a substance abuse disorder and to assist them in accessing treatment.
I encourage all to read the recently released “Comprehensive Federal Strategy for Addressing America’s Prescription Drug and Heroin Epidemic” here.
In many ways, we have been reminded to go back to the basics, taking time to do a complete focused history and physical exam on patients and individualizing treatment plans. By applying the MLB’s final rules, I am confident we will see in our state a reduction in excessive prescribing of opioids in treatment of chronic pain, a reduction in diversion of opioids for illicit use, and a dramatic reduction of overdose deaths from opioids.
In the end, we will have fulfilled the axiom all physicians should follow: First, do no harm.