Match Context and Document information |
These search terms are highlighted: dea verification
URL: | https://www.deadiversion.usdoj.gov/...18/aug_2018/arnold.pdf |
Depth: | 4 clicks away from Home |
Size: | 2,540,693 bytes |
Modified: | 2024-05-28 12:28:33 |
Categories: | -None- |
Title: | The Opioid Epidemic and the Practice of Legitimate Medicine |
Description: | -None- |
Keywords: | -None- |
Meta data: | -None- |
Body: | The Opioid Epidemic
and the
Practice of Medicine
James Arnold, Chief
Liaison and Policy
Diversion Control Division
Practitioner Diversion Awareness Conference
Louisville, Kentucky
August 6 and 7, 2018
2
LEGAL DISCLAIMER
The following presentation was accompanied by
an oral presentation on August 6-7, 2018, and
does not purport to establish legal standards that
are not contained in statutes, regulations, or
other competent law. Statements contained in
this presentation that are not embodied in the
law are not binding on DEA. Summaries of
statutory and regulatory provisions that are
summarized in this presentation do not purport
to state the full extent of the statutory and
regulatory requirements of the cited statutes and
regulations. I have no financial relationships to
disclose.
This presentation is for educational purposes only. This
presentation may not be further copied or used, with the
embedded images and videos, without an independent analysis of
the application of the Fair Use doctrine.
Fair Use
Under section 107 of the Copyright Act of 1976, allowance is
made for "Fair Use" for purposes such as criticism, comment,
news reporting, teaching, scholarship, education and research.
Fair Use is a use permitted by the copyright statute that might
otherwise be infringing. Any potentially copyrighted material
used in this presentation has been reviewed and found to be used
in a manner consistent with Fair Use. A completed Fair Use
checklist is attached.
Fair Use Act Disclaimer
Objectives
To Introduce the DEA registered Practitioner
with:
.
Real Mission of the Diversion Control
Division of the DEA
.
Extent of the Opioid Epidemic in the U.S.
.
History and Complexity of Drug Abuse in
the U.S.
.
Trends in Prescribing and Dispensing
Patterns
.
Nationwide Efforts to Combat the Problem
Questions To Discuss
At the completion of this block of instruction you
will be able to answer the following questions:
1.
What limits has Kentucky placed on Schedule 2
controlled substance prescriptions?
2.
What are the top three most commonly
prescribed controlled substances in the U.S.?
Questions To Discuss
3.
According to the CDC approximately how
many people died from drug overdoses in the
year 2016?
4.
Under Federal Law what is the primary
responsibility of practitioners when it comes to
issuing prescriptions for controlled
substances?
5.
According to IMS Data the total number of
prescriptions being filled for oxycodone for the
last three years has declined?
There
Is
Pain
7
There
Is
Legitimate
Pain
8
There
Is
Dependence
9
There
Is
Addiction
10
The mission of the Diversion
Control Division is to prevent,
detect, and investigate the
diversion of pharmaceutical
controlled substances and listed
chemicals from legitimate
channels of distribution...
Mission
11
... while ensuring an adequate
and uninterrupted supply of
controlled substances to meet
legitimate medical, commercial,
and scientific needs.
Mission
12
21 C.F.R. § 1306.04 (a)
A prescription for a controlled
substance to be effective must be
issued for a legitimate medical
purpose by an individual
practitioner acting in the usual
course of his professional
practice.
13
U.S. Drug Enforcement Administration
Diversion Control Division
Public Health Epidemic
In 2014, there were 47,055 drug
overdose deaths,
...one death every 11.16 minutes,
...approximately 128 per day,
...19,000 were due to prescription
opioid pain relievers
1.
Rudd R, et al. MMWR Morb Mortal Wkly Rep. 2016 Jan 1;64:1378-82.
2.
CDC. https://www.cdc.gov/drugoverdose/data/analysis.html. Feb 2017. Accessed May 2017.
Public Health Epidemic
In 2015, there were 52,404 drug
overdose deaths,
...one death every 10.06 minutes,
...approximately 143 per day,
...22,598 were due to prescription
opioid pain relievers
National Institute on Drug Abuse. 2017. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Public Health Epidemic
In 2016, there were 63,632 drug
overdose deaths,
...one death every 8.28 minutes,
...approximately 174 per day,
...42,249 were due to opioids
National Institute on Drug Abuse. 2017. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Soldier Field
Capacity: 61,500
16,849
17,415
19,394
23,518
25,785
27,424
29,813
34,425
36,010
36,450
37,004
38,329
41,340
41,502
43,982
47,055
52,404
63,632
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Number
of
Deaths
Drug Poisoning Deaths, 1999-2016
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-
2016 on CDC WONDER Online Database, released 2017. Data on drug poisoning deaths were extracted by ONDCP
from http://wonder.cdc.gov/mcd-icd10.html on December 21, 2017. 12/2016
PAST 10 YEARS
(2006-16) +85%
PAST 5 YEARS
(2011-16) +54%
PAST 15 YEARS
(2001-16) +228%
Public Health Epidemic
Sharpest Increase in Drug Overdose
Deaths
2016
Fentanyl and Fentanyl Analogues
(Synthetic Opioids)
with over 20,000 Deaths
National Institute on Drug Abuse. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Heroin Seizure Pharmaceutical Oxycodone 30mg
U.S. Drug Enforcement Administration
21
U.S. Drug Enforcement Administration
Ten Most Commonly Prescribed
Controlled Substances in the U.S.
.
Hydrocodone
.
Oxycodone
.
Alprazolam
.
Tramadol
.
Zolpidem
.
Clonazepam
.
Lorazepam
.
Dextroamphetamine
.
Codeine
.
Methylphenidate
22
IMS Data on file.
The Most Common Drugs
Involved in Prescription Opioid
Overdose Deaths
23
Oxycodone
Hydrocodone
Methadone
CDC. https://www.cdc.gov/drugoverdose/data/overdose.html. Accessed: May 2017
Unfortunately,
The United States
has a Long History
of
Drug Use
and
Abuse
24
Intoxication: The Universal Drive for
Mind Altering Substances
"Dr. Ron Siegel has suggested that throughout
our entire history as a species, intoxication
has functioned like the basic drives of hunger,
thirst, or sex, sometimes overshadowing all
other activities in life. Siegel further
suggested "intoxication is the fourth drive".
"Individual and group survival depends on
the ability to understand and control this
basic motivation to seek out and use
intoxicants."
David V. Gauvin, Director, Department of Neurobehavioral Sciences, MPI Research: "A "Budding" Cannabis Cottage Industry Has
Set the Stage for an Impending Public Health Crisis", Pharmaceutical Regulatory Affairs: Open Access 2018, Volume 7, Issue 1
1804
Morphine is Distilled from
Opium for the First Time
26
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
27
1839
The First Opium War Breaks
Out as Britain Forces China to
Sell Its India Grown Opium
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
28
1853
The Hypodermic Syringe is
Invented
The Inventor's Wife is the First to
Die of an Injected Drug Overdose
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
U.S. Drug Enforcement Administration
Diversion Control Division
29
1861-1865
Morphine Addiction
The Civil War
The "Soldier's Disease"
30
1898
Bayer Chemist Invents
diacetlymorphine,
Names It Heroin
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
31
Advent of the 20th Century
Abuse Of Opium And Morphine A
Significant Problem In The US
But
There Was Widespread
Distribution Of Medicinal Products
Containing The New
"Non-addictive" Alternative To
Morphine -Heroin.
32
33
34
35
36
37
38
39
40
41
42
43
44
February 9, 1909
Congress
Public Law 221
"An Act to Prohibit the
Importation and Use of Opium
for Other Than Medicinal
Purposes"
45
1914
U.S. Congress Passes Harrison
Tax Act
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
46
1928
Committee on the Problems of
Drug Dependence is Formed
To Organize Research in Pursuit
of the Holy Grail:
A Non-addictive Painkiller
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
47
1951
Arthur Sackler Revolutionizes
Drug Advertising
With Campaign for the
Antibiotic Terramycin
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
48
1960
Arthur Sackler's campaign for
Valium makes it the industry's
first $100 million drug
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
49
1980
The New England Journal of
Medicine publishes a letter to
the editor that becomes known
as "Porter and Jick"
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
ADDICTION RARE IN PATIENTS
TREATED WITH NARCOTICS
50
Jane Porter
Hershel Jick, M.D.
Boston Drug Surveillance Program
Boston University Medical Center
New England Journal of Medicine.
January 1980
http://www.nejm.org/doi/pdf/10.1056/NEJ
M1980011030020221
ADDICTION RARE IN PATIENTS
TREATED WITH NARCOTICS
"We conclude that despite
widespread use of narcotic drugs in
hospitals, the development of
addiction is rare in medical patients
with no history of addiction."
51
52
1986
Drs. Kathleen Foley and
Russell Portenoy publish
paper in the journal Pain,
opening a debate about use of
opiate painkillers for wider
variety of pain
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
53
1996
Purdue releases OxyContin,
timed-released oxycodone,
marketed largely for
chronic-pain patients
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
54
1996
Dr. David Procter's clinic in
South Shore, Kentucky, is
presumed
the nation's first pill mill
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
55
1996
President of American Pain
Society urges doctors to treat
pain as a vital sign
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
56
2002
Dr. David Procter pleads
guilty to drug trafficking and
conspiracy and serves eleven
years in federal prison
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
57
2007
Purdue and three executives
plead guilty to misdemeanor
charges of false branding of
OxyContin; fined $634 million
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
58
2008
Drug overdoses, mostly from
opiates, surpass auto fatalities
as leading cause of accidental
death in the United States
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
59
2011
Ohio passes House Bill 93,
regulating pain clinics
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
60
2013
The College on the Problems
of Drug Dependence turns
seventy-five without finding
the Holy Grail of a
nonaddictive painkiller
Sam Quinones, 2015, Dream Land: The Tale of America's Opiate Epidemic
The
Problem
Affects
Everyone
61
No one
Is
Un-Affected
62
WA
OR
MT
ID
WY
ND
SD
MN
IA
NE
WI
MI
CO
KS
MO
IL
IN
UT
NV CA
AZ NM
OK
TX
AK
AR
LA
TN
KY
MS
AL
GA
SC
NC
OH
VA
PA
NY
ME
V
T
N
J
MD
RI
DC
DE
HI
V
W
FL
H
N
PR
DEA Registrants as of July 31, 2018: 1,763,068
Importers 270
Manufacturers 580
Narcotic Treatment
Programs 1,661
Research/Analysis
13,206
Distributors 943
71,876 1,655,947 17,977
Pharmacies Practitioners Hospitals
Patients (U.S. pop.)
327,109,224
63
Exporters 277
64
Livonia doctor, 7 others charged
in $18M prescription drug
scheme
January 9, 2018
http://www.fox2detroit.com/news/local-news/livonia-doctor-7-others-
charged-in-18m-prescription-drug-scheme
"Great Falls pharmacy manager
charged with stealing drugs"
January 12, 2018
Seaborn Larson, Great Falls Tribune,
https://www.greatfallstribune.com/story/news/crime/2018/01/12/great-falls-
pharmacy-manager-charged-stealing-drugs/1029290001/
65
"Police: Maryland officer arrested
after he stole opioids from a
bedridden citizen"
February 2, 2018
Brad Bell, WJLA News, http://wjla.com/news/local/md-police-officer-arrested-
sources-say-he-was-allegedly-stealing-opioids-from-citizens
U.S. Drug Enforcement Administration
Diversion Control Division
66
"Ex-dentist pleads guilty to
illegally prescribing drugs"
February 5, 2018
Fox 61, http://fox61.com/2018/02/05/ex-dentist-pleads-guilty-to-illegally-
prescribing-drugs/
U.S. Drug Enforcement Administration
Diversion Control Division
67
"More than a dozen people arrested
in Bloomington drug investigation"
February 6, 2018
Fox59 News, http://fox59.com/2018/02/06/more-than-a-dozen-people-arrested-in-
bloomington-drug-investigation/
U.S. Drug Enforcement Administration
Diversion Control Division
68
"Doctor prescribed needless pills
and bilked Medicare, feds say"
February 12, 2018
Paula McMahon, Sun Sentinel, http://www.sun-sentinel.com/local/broward/fl-
reg-doctor-arrested-fraud-pain-pills-20180212-story.html
U.S. Drug Enforcement Administration
Diversion Control Division
69
"Las Vegas doctor charged with
unlawful distribution of opioid,
health care fraud"
February 14, 2018
Brenda Yahm, Fox 5 Vegas, http://www.fox5vegas.com/story/37505788/las-vegas-
doctor-charged-with-unlawful-distribution-of-opioid-health-care-fraud
U.S. Drug Enforcement Administration
Diversion Control Division
70
"Nurse arrested for forging opioid
prescriptions"
February 18, 2018
Jesse Leavenworth, EMS1, https://www.ems1.com/opioids/articles/375512048-
Nurse-arrested-for-forging-opioid-prescriptions/
U.S. Drug Enforcement Administration
Diversion Control Division
71
"Federal agents raid doctor's
office and suspected 'pill mill'"
February 27, 2018
Lee Zurik, Megan Luther, and Andy Miller, WTXL News,
http://www.wtxl.com/news/federal-agents-raid-doctor-s-office-and-suspected-
pill-mill/article_0e8a0064-1bf3-11e8-b409-cb776b750102.html
U.S. Drug Enforcement Administration
Diversion Control Division
72
"Doctor accused of trading
prescription drugs for sex; 44
arrested in massive bust"
March 1, 2018
Mark Winne, WSBTV, http://www.wsbtv.com/news/local/doctor-accused-of-trading-
prescription-drugs-for-sex-44-arrested-in-massive-bust/709268909
U.S. Drug Enforcement Administration
Diversion Control Division
73
Philadelphia doctors charged in $5M prescription drug bust
By Dann Cuellar
Thursday, May 12, 2016
SOUTH PHILADELPHIA (WPVI) --
According to a federal indictment, three doctors illegally sold over $5 million
worth of prescription drugs out of their now-defunct Philadelphia clinic on
South Broad Street.
Two Mobile Pain Doctors Arrested On
Drug And Fraud Charges
Wednesday, May 20, 2015
United States Attorney Kenyen R. Brown of
the Southern District of Alabama, along with
FBI-Mobile Special Agent in Charge Robert
Lasky, and DEA-Mobile Special Agent in
Charge Keith Brown, New Orleans Field
Division, announce the arrests of Dr. John
Patrick Couch and Dr. Xiulu Ruan.
What's Trending
77
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
2009
2010
2011
2012
2013
2014
2015
2016
2017
Total Prescriptions Filled : Hydrocodone 2009-2017
IMS Data
78
48,000
50,000
52,000
54,000
56,000
58,000
60,000
62,000
64,000
2009
2010
2011
2012
2013
2014
2015
2016
2017
Total Prescriptions Filled: Oxycodone 2009-2017
IMS Data
79
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
2009
2010
2011
2012
2013
2014
2015
2016
2017
Total Prescriptions Filled: Methadone 2009-2017
IMS Data
80
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
2009
2010
2011
2012
2013
2014
2015
2016
2017
Total Prescriptions Filled: Buprenorphine 2009-2017
IMIMS
IMS
Total Controlled Substance Rx's Filled
500,000
510,000
520,000
530,000
540,000
550,000
560,000
570,000
580,000
590,000
2009
2010
2011
2012
2013
2014
2015
2016
In
Thousands
Total Controlled Substance Rx's 2009-2016 Data from IMS
82
Opioid addiction is plateauing. But the crisis isn't
over.
Vox
By Dylan Scott
New data from the Blue Cross Blue Shield
Association suggests opioid addiction rates are finally
plateauing.
The big finding from the BCBSA data, which
compiles medical claims information from the various
Blue Cross affiliates across the United States:
Diagnoses of opioid use disorder (addiction, in other
words) declined from 2016 to 2017, from 6.2 per
1,000 patients to 5.9.
*As of July 31, 2018: DEA Data
Opioid Treatment Programs (OTPs)
1,375
1,418
1,509
1,595
1,662
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2014
2015
2016
2017
2018
Opioid Treatment Program (OTP) Totals
4
25
166
78
28
82
4
13
4
71
17
DC 5
43
22
45
7
19
10
10
83
86
10
45
16
17
5
4
71
3
4
9
16
41 16
130
19
38
93
19
6
83
15
21
1
95
16
42
1
10
27
20
9
0
DEA Registered
Opioid Treatment Programs (OTP)
Drug Enforcement Administration, Diversion Control Division,
Updated July 31, 2018
Total: 1,662
85
*As of July 31, 2018 (Addition of NPs and PAs as of 01/01/2017)
DEA Registered Qualifying
Practitioners
14,778
27,719
49,643
0
10,000
20,000
30,000
40,000
50,000
60,000
2010
2015
2018
Data Waived Physician (DWP)/Qualifying Practitioner Totals
265
538
5228 940
1006
200
157
179
885
174
DC 200
1009
956
996
163
804
178
538
2704
1637
694
1328
592
580
243
138
1304
70
99
425
590
1496 364
4831
372
2516
2725
904
458
418
841
557
71
1680
607
858
2
342
1920
702
411
71
DEA Registered Qualifying Practitioners
Drug Enforcement Administration, Diversion Control Division Updated 7/31/2018
Guam: 2
Nationwide Efforts
to
Combat
the Problem
88
States
Practitioners
Hospitals
Treatment Providers
Medical Schools
Pharmacies
States with Limits CII
Alaska 7 Day Supply (initial prescription)
Arizona 7 Day Supply (initial prescription)
7 Day Supply (for minors)
Connecticut 7 Day Supply (initial prescription)
7 Day Supply (for minors)
Delaware Up to 100 dosage units or a
31 day supply, whatever is greater
89
States with Limits CII
.
District of Columbia 7 Day Supply
(emergency situation)
.
Florida 3 Day Limit/Acute Pain
7 Day Supply/Medically Necessary
.
Hawaii 30 Day Supply
.
Illinois 30 Day Supply: CII
(Some exceptions under certain
conditions)
.
Indiana 7 Day Supply (initial prescription)
7 Day Supply (for minors)
90
States with Limits CII
91
Kansas 30 Day Supply
(Substances to treat obesity)
Kentucky 3 Day Supply (acute pain) with
exceptions: e.g. Chronic Pain, Cancer
Pain, End of Life, Hospice, Narcotic
Drug Treatment, Major Surgery.
Louisiana 10 Day Supply: CII-III
(Prescribers not licensed in Louisiana)
Maine 30 Day Supply (chronic pain)
7 Day Supply (acute pain)
States with Limits CII
92
Massachusetts 7 Day Supply (unless more in
indicated)
7 Day Supply (all opioids for minors)
Massachusetts 30 Day Supply: CII-III
60 Day Supply (Dextroamphetemine)
Missouri 30 Day Supply: CII
90 Day (If medical reason given)
New Hampshire 34 Day Supply: CII
60 Day Supply (ADD/ADHD)
States with Limits CII
93
New Jersey First prescription: 5 Day Supply
New York 30 Day Supply
7 Day Supply (initial prescription)
North Carolina 5 Day Supply (acute pain)
Ohio 7 Day Supply
5 Day Supply (for minors)
Oregon 7 Day Supply (initial prescription)
7 Day Supply (for minors)
States with Limits CII
94
Pennsylvania 7 Day Supply (for minors)
7 Day Supply
(emergency department
and urgent care centers)
Rhode Island 20 Doses for opioids (initial
prescription)
No more than 30 morphine
MME/day
South Carolina 31 Day Supply
(Except Transdermal patches)
90 Day Supply: CIII-V
States with Limits CII
95
Tennessee 30 Day Supply of Opioids and
Benzodiazepines
Texas 90 Day Supply (multiple
prescriptions)
Utah 30 Day Supply: CII
Vermont 90 Day Supply
72 MME (first prescription for
minors)
350 MME - 7 Day limit (acute pain,
first prescription)
States with Limits CII
96
Virginia Limitations on Number of Days
7 Day Supply (acute pain)
14 Day Supply (surgical procedures)
(Some exceptions)
Washington 7 Day Supply (initial prescription)
3 Day Supply (dentist)
West Virginia 72 Hour Supply
30 Day Supply: Hydrocodone
CVS Pharmacy Policy: 2/01/18
.
Acute Pain (Opioid Naïve Patients: No
Opioid Script within the Past Year)
.
7-Day Supply
.
Opioid Prescriptions
.
Requirement to Counsel Patients:
-
Risks Of Addiction
-
Secure Storage Of Medications In The
Home
-
Proper Disposal of Medications
97
98
Walmart giving away solution to dispose
of unused prescription pills
January 26, 2018
Gene Myers, Staff Writer, @myersgene
99
Narcan available at more than 8,000
Walgreens locations nationwide
.
CBS News, By Peter Martinez: October 27, 2017
.
Walgreens (WBA) is now stocking Narcan at all
of its more than 8,000 locations nationwide, the
company announced Thursday. The nasal spray,
which is an FDA-approved form of naloxone,
can reverse the effects of an opioid overdose.
.
The drug store chain said the move was "part of
its comprehensive national plan to combat drug
abuse" and help the communities it serves.
100
Knowing the Risks of Opioid Prescription Pain
Medications (Rite Aid)
Opioid prescription pain medications are a type of medicine used to relieve pain.
Some of the common names include oxycodone and acetaminophen (Percocet®);
oxycodone, (OxyContin®); and hydrocodone and acetaminophen (Vicodin®).
These medications...
. Cause your brain to block the feeling of pain; they do not treat the underlying cause of
pain.
. Are very addictive, especially if they are not used correctly.
. Increase your chances of accidental overdose, coma, and death if taken with
prescription medications, including anti-anxiety and sedating medications, and alcohol.
Effective non-opioid options are available for relieving short-term pain, including ibuprofen
(Advil®, Motrin®), acetaminophen (Tylenol®), physical therapy, chiropractic, acupuncture,
and cognitive behavioral therapy. Talk with your pharmacist or healthcare provider to learn
more.
101
Protect yourself - and your loved ones - with
Naloxone (Rite Aid)
What is Naloxone?
. Naloxone is a lifesaving, rescue medication that can be used in an emergency to reverse
the effects of an accidental opioid overdose.
Why should I get Naloxone?
. Any prescription opioid medication has the potential risk for unintended
consequences such as slowed breathing and accidental overdose.
. Guidelines recommend naloxone if you take high doses of opioids, certain interacting
medications or have medical condition(s) that increase your risk.
. Having naloxone at home can not only protect yourself, but loved ones that may ingest the
opioid by accident - an emergency can occur after just one dose.
. Similar to a fire extinguisher in your home, naloxone is important to have "just in case" of
an emergency or accident it is always better to take appropriate precautions and be safe!
Walmart Will Implement New Opioid
Prescription Limits By End Of Summer
102
Vanessa Romo, May 8, 2018
Non-opioid medication outperforms
opioids for chronic pain, study shows
The Washington Times
By Laura Kelly
Journal of the American Medical Association,
March 6, 2018
104
Reducing opioids not associated with
lower patient satisfaction scores, study
finds
Science Daily
A Kaiser Permanente study of nearly 2,500 patients who used high doses of
opioids for at least six months showed that reducing their opioid use did
not lower their satisfaction with care. The study, "Satisfaction With Care
After Reducing Opioids for Chronic Pain," was published today in The
American Journal of Managed Care.
"Physicians are often concerned they will receive lower satisfaction scores if
they reduce opioids for patients who are accustomed to high opioid doses to
manage chronic pain," said the study's lead author, Adam L. Sharp, MD, MS,
of Kaiser Permanente Southern California Department of Research &
Evaluation. "This study showed that following current recommendations and
reducing opioids for chronic pain did not result in lower satisfaction scores."
105
Could DNA help doctors predict opioid addiction?
MDDI
By Kristopher Sturgis
New research out of Bentley University aims to
explore the genetic links between human DNA and
opioid addiction. The new study could help doctors
identify patients susceptible to opioid dependence and
choose different treatment methods.
The research project aims to help better inform
doctors on how likely a patient is to become addicted
to opioids before ever prescribing opioid drugs. The
new data could also be used to predict how patients
addicted to opioids will respond to certain treatments.
106
"Tylenol, Motrin just as effective
in treating pain in ER patients as
opioids"
November 7, 2017
Lindsey Tanner, November 7, 2017, The Denver Post,
https://www.denverpost.com/2017/11/07/tylenol-motrin-effective-treating-pain-er-
patients-as-opioids/
107
FDA approves the first non-opioid
treatment for management of opioid
withdrawal symptoms in adults
Encouraging more widespread
innovation and development of safe and
effective treatments for
opioid use disorder remains top agency
priority
CDC
.
New project to estimate best practice opioid
prescribing in the United States.
.
Using large health insurance claims data,
CDC will estimate current opioid prescribing
rates in the US for various conditions and
procedures. Using clinical guidelines and
related research, CDC will estimate what the
prescribing rates would be for these
conditions and procedures if best practices
were followed.
108
DEA Initiatives
110
191
784
1254
1404
0
200
400
600
800
1000
1200
1400
1600
2015
2016
2017
2018
HQ and Field Outreach Totals FY2015-June 30, 2018
EOY Total
111
Dear DEA-Registered Practitioner - February 2018
CDC's Recommendations for the Prescribing of Opioid Pain Medications
Dear DEA-Registered Practitioner:
In March, 2016, the Centers for Disease Control and Prevention (CDC) published its "CDC Guideline for Prescribing Opioids for
Chronic Pain" to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care
settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time
of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.
CDC's Guideline is part of a comprehensive approach to addressing the opioid overdose epidemic and is one step toward a more
systematic approach to the prescribing of opioids, while ensuring that patients with chronic pain receive safer and effective pain
management. According to the CDC, The Guideline's twelve recommendations, published in August 2017, are based on three key
principles:
1.
Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care. Opioids should only
be used when their benefits are expected to outweigh their substantial risks.
2.
When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and
overdose. Clinicians should start low and go slow.
3.
Providers should always exercise caution when prescribing opioids and monitor all patients closely. Clinicians should minimize
risk to patients-whether checking the state prescription drug monitoring program, or having an 'off-ramp' plan to taper.
You are receiving this email as part of DEA's effort to improve its communication with its more than 1.7 million registrants while
simultaneously improving the dissemination of the CDC Guidelines to those authorized to prescribe opioids.
A copy of CDC's publication entitled, "Guideline for Prescribing Opioids for Chronic Pain: Recommendations" may be found at:
https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf.
Additionally, an Interactive Training Webinar for providers who prescribe opioids may be found at:
https://www.cdc.gov/drugoverdose/training/index.html.
Taken from CDC.gov - More than 11 million people abused prescription opioids in 2016.
112
Opioid Addiction Resources - March 16, 2018
Opioid Addiction Resources
Resources for DEA Registered
Practitioners for Patients Who May
Be Dependent and/or Addicted To
Opioids
According to the U.S. Centers for Disease
Control and Prevention (CDC) there were
63,632 drug overdose deaths in the United
States in 2016; 174 deaths per day; one death
every 8.28 minutes; 42,249 (66.4%) of those
deaths were due to opioids. More deaths than those as a result of firearms,
homicide, suicide, and motor vehicle crashes.
Practitioners are in a unique position to help combat the current opioid epidemic in
this country. Please take time to understand and recognize the signs of this disease
in your patients. If you or anyone in your office suspects that a patient may have a
problem with opioid dependence, please provide your patients with the below listed
information so they, or someone in their family, can get the help that they may
need.
Practitioners may also wish to talk with their patients who are currently taking opioids
for a legitimate medical issue about the benefits of naloxone (e.g. Narcan®, Evzio®)
in the case of an overdose situation which may involve themselves or anyone in their
family. These types of products can rapidly reverse the effects of an opioid overdose
and are the standard treatment for these types of situations. Information on
naloxone products can be found at www.fda.gov.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has a
National Helpline, 1-800-662-HELP (4357), for those with a possible opioid use
disorder. The Helpline is a confidential, free, 24-hour-a-day, 365-day-a-year,
information service, in English and Spanish, for indiv
iduals and family members facing
mental and/or substance use disorders. This service provides referrals to local
treatment facilities, support groups, and community-based organizations. Callers can
also order free publications and other information here.
To find an authorized Opioid Treatment Program dispensing methadone or
buprenorphine to treat opioid dependency in your state visit:
113
Use of Telemedicine While Providing MAT - May 15, 2018
The Use of Telemedicine While Providing Medication
Assisted Treatment (MAT)
Under the Ryan Haight Act of 2008, where controlled
substances are prescribed by means of the Internet, the
general requirement is that the prescribing Practitioner must
have conducted at least one in-person medical evaluation of
the patient. U.S.C. § 829(e). However, the Act provides an
exception to this requirement. 21 U.S.C. § 829
(e)(3)(A). Specifically, a DEA-registered Practitioner acting
within the United States, is exempt from the requirement of
an in-person medical evaluation as a prerequisite to
prescribing or otherwise dispensing controlled substances by
means of the Internet, if the Practitioner is engaged in the practice of telemedicine and is acting in
accordance with the requirements of 21 U.S.C. § 802(54).
Under 21 U.S.C. § 802(54)(A),(B), for most (DEA-registered) Practitioners in the United States,
including Qualifying Practitioners and Qualifying Other Practitioners ("Medication Assisted
Treatment Providers") who are using FDA approved Schedule III-V controlled substances to treat
opioid addiction, the term "practice of telemedicine" means the practice of medicine in accordance
with applicable Federal and State laws, by a practitioner (other than a pharmacist) who is at a
location remote from the patient, and is communicating with the patient, or health care professional
who is treating the patient, using a telecommunications system referred to in section 1395m(m) of
Title 42 (42 C.F.R. § 410.78(a)(3)), which practice is being conducted:
A. while the patient is being treated by, and physically located in, a DEA-registered
hospital or clinic registered under 21 U.S.C. § 823(f) of this title; and by a practitioner
-who is acting in the usual course of professional practice;
-who is acting in accordance with applicable State law; and
-is registered under 21 U.S.C. § 823(f) with the DEA in the State in which the patient is located.
OR
B. while the patient is being treated by, and in the physical presence of, a DEA-
registered practitioner
-who is acting in the usual course of professional practice;
-who is acting in accordance with applicable State law; and
-is registered under 21 U.S.C. § 823(f) with the DEA in the State in which the patient is located.
Safe Prescribing Saves Lives
Use the resources below to learn more about DEA, SAMHSA, and CDC
working together to help you prescribe with confidence
www.cdc.gov/RxAwareness
www.getsmartaboutdrugs.gov
115
Do You or a Family Member
Need Help with Drugs?
1-800-662-HELP (4357)
A Final Note
Prevention/Detection
Education
Treatment
Enforcement
Solutions to the Problem
117
Post Questions
1.
What basic limits has Kentucky placed
on Schedule 2 controlled substance
prescriptions for treating acute pain?
A.
3 Day Supply
B.
7 Day Supply/Medically Necessary
C. 14 Day Supply
D. 28 Day Supply
Post Questions
2.
What are the top three most commonly
prescribed controlled substances in
the U.S. ?
A.
Hydrocodone
B.
Methadone
C. Oxycodone
D. Alprazolam
E.Tramadol
F. A,C, & D.
Post Questions
3. According to the CDC approximately
how many people died from drug
overdoses in the year 2016?
A. 52,404
B. 47,055
C. 63,632
Post Questions
4.
Under Federal Law what is the primary
responsibility of practitioners when it
comes to issuing prescriptions for
controlled substances?
A.
A prescription must be issued for a
legitimate medical need.
B.
A prescription must issued in the usual
course of professional practice.
C.
A&B
Post Questions
5.
According to IMS Data the total
number of prescriptions being filled
for oxycodone for the last three years
has declined?
A.
Yes
B. No
Thank You
123
124
Contact Information
James Arnold, Chief
Liaison & Policy Section/DRL
Drug Enforcement Administration
8701 Morrissette Drive
Springfield, Virginia 22152
James.A.Arnold@usdoj.gov
202-353-1414 (Office)
|
|