Every day an average of 130 people die from an overdose of opioids — sometimes from opioids originally prescribed in good faith by doctors. One response has been tightening of opioid prescribing rules, with the unintended consequence of making it more difficult for physicians to treat chronic pain.
“There is a lot of emphasis on the total amount of pain medicine prescribed to patients on a daily basis,” says Dr. Dan Barnes, D.O., president of FirstHealth Physician Group. “It requires providers to be able to make changes to treatment plans that address pain but reduce the risk of adverse events.”
The right balance
These new rules and laws regarding prescribing opioids for pain management pose new challenges.
“Balancing compassion for those in pain against the risk of prescribing a medication that could cause a multitude of other problems is always a difficult call,” says Dr. Gregory Esslinger, D.O., a family practice physician with Major Health Partners in Indiana. “We have reached the ‛crisis’ stage because physicians were dealt the impossible goal of making patients ‛pain-free.’”
Both Dr. Esslinger and Dr. Barnes have adjusted how they approach pain management. “Health care professionals need to emphasize the importance of pain prevention,” says Esslinger. “This begins years before our patient actually develops pain. It has been amazing to me how much chronic pain I have successfully treated utilizing other pain control modalities.”
“There’s a lot more effort on trying to eliminate the cause of pain as opposed to just masking the symptoms with daily opioids,” notes Barnes.
New tools
Opioids remain a powerful tool for pain management, however. Many physicians are looking for help with safe prescribing through compliance with guidelines and guarding against addiction and misuse.
“Nearly 12 months ago, we implemented a controlled substance monitoring and compliance program in connection with GuideMed®,” a prescription narcotics monitoring program, Esslinger says. “One of the most impressive things that GuideMed performs is accurate monitoring of our patients on chronic opioid therapy. GuideMed accepts responsibility for ensuring my colleagues and me follow the various regulatory requirements of opioid therapy monitoring and turns them into protocols for our physicians to follow.”
Dr. Barnes has also had positive experiences with GuideMed. “Our partnership has helped to cover the requirements established by the North Carolina Medical Board, ensuring that every patient has a safety contract on file,” he says. “They also helped us develop protocols to determine risk and then base random drug screening on the overall risk classification. Additionally, they provide us with reports showing patients who are outside the window for compliance and the number of patients on high doses of opioids. That helps us develop treatment plans around some of those patients who are at higher risk.” GuideMed creates safe prescribing protocols through monitoring while also identifying patients at risk of drug misuse.
The GuideMed program has produced extremely encouraging initial outcomes results. Data from more than 100 providers and 4,000 patients show inconsistent drug tests declined by 43 percent in a West Virginia healthcare system and 34 percent in a large Indiana-based system, and system-wide 50 percent improvements for both compared to the national average. A separate study involving nearly 4,000 patients and 96 providers found physician and patient compliance jumped from 46 percent to 100 percent in Indiana and from 11 percent to 98 percent in South Carolina.
“We want to appropriately address prescribing patterns or aberrant behaviors before they become long-term problems which put our patients at increased risk,” says Esslinger. “The GuideMed program has allowed MHP to provide safer and more effective care to our patients taking controlled substances and has brought more awareness to our Medical Staff.”