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Need to change prescribing practices in Indiana termed 'urgent'
e-Reports, July 14, 2014
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Sometimes being in the top 10 generates feelings of pride and accomplishment. For Indiana, news from the Centers for Disease Control and Prevention (CDC) on July 1 brings the opposite kinds of feelings.

Tramadol to become scheduled drug in August
The DEA has newly classified tramadol as a schedule IV drug, effective August 18. More details to come next issue.

Find the Final Rule at the Federal Register.

KEY POINTS from the CDC’s Morbidity & Mortality Report, July 1, 2014

  • Opioid pain relievers and benzodiazepine sedatives are commonly prescribed in the U.S. and frequently prescribed to the same patient.
  • Overprescribing of opioid pain relievers can result in multiple adverse health outcomes, including fatal overdoses.

Our state ranked among the top 10 for the number of painkiller prescriptions per 100 people in a report from a National Prescription Audit, using 2012 data. Overall, health care providers in the U.S. wrote 259 million prescriptions for opioid painkillers in 2012.

“States and practices where prescribing rates are highest need to take a particularly hard look at ways to reduce the inappropriate prescription of these dangerous drugs,” said CDC Director Tom Frieden, M.D., M.P.H. The CDC said that in states with results like ours, “the need for a change in prescribing practices is urgent.”

The study highlighted regional variations in use of prescriptions that could not be explained by the underlying health status of the population. Most of the highest prescribing states were in the South, but Indiana providers wrote 109 painkiller prescriptions per 100 citizens.

Florida reverses the trend
The CDC pointed to actions in Florida that successfully reduced death rates for oxycodone, methadone, hydrocodone and sedatives that paralleled a decrease in prescribing rates for those drugs. The state took serious steps to reduce pain clinics or “pill mills” and made other policy changes.

Florida Oxycodone

The CDC recommends steps other states can take to address the overprescribing of painkillers.

  • Identify ways to increase use of prescription drug monitoring programs, which are state-run databases that track prescriptions for painkillers and help find problems in overprescribing. Indiana’s program is INSPECT available at www.in.gov/pla/inspect. Impact of these programs is greater when they make data available in real time, are universal (used by all prescribers for all prescriptions for all controlled substances), and are actively managed (for example, sending alerts to prescribers when problems are identified).
  • Consider policy options, including laws and regulation, relating to pain clinics to reduce prescribing practices that are risky to patients.
  • Evaluate your data and programs and consider ways to assess Medicaid, workers’ compensation programs and other state-run health plans to detect and address inappropriate prescribing of painkillers.
  • Identify opportunities to increase access to substance abuse treatment and consider expanding first responder access to naloxone for people who overdose.

Read more about the report here.

Here’s a free tool from Substance Abuse and Mental Health Services Administration – Managing chronic pain in adults with or in recovery from substance use disorders 

A free quick reference guide provides busy clinicians with concise, easily accessed, how-to information on chronic non-cancer pain, pain management, treatment and recovery for adults with substance use disorders.

It covers patient assessment through treatment and includes an algorithm for managing chronic pain and a summary of non-opioid analgesics.

Find the tool here.

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