Before doctors write prescriptions for powerful pain killers for patients in short-term pain, they should consider alternative therapies, according to new guidelines issued by the state on Tuesday to help curb opiate addiction and accidental overdoses.
“What we are trying to do — bottom line — is save lives,” said Andrea Boxill, deputy director of Gov. John Kasich’s Opiate Action Team.
The team issued prescribing guidelines for emergency rooms and acute care facilities in April 2012 and for chronic pain management clinics in October 2013. The latest guidelines are aimed at doctors treating patients for acute pain that often arises from dental procedures, surgeries or injuries.
Dr. Mary DiOrio, medical director at the Ohio Department of Health, said doctors should first consider prescribing physical therapy, ice or heat, massage or over-the-counter pain relievers before deciding to issue powerful narcotic pain killers.
The new guidelines call for limiting the number of pills issued per prescription, avoiding long-acting opioids, checking the state’s prescription drug database before writing the script, reevaluating patients after two weeks, and considering non-drug and non-opioid therapies to deal with short-term pain. About 35 percent of the prescribed doses of opioids in Ohio are for acute pain management.
Dr. Amol Soin, who operates pain management clinics in the Miami Valley, said the goal of the new guidelines is to prevent opiate addiction but still preserve doctors’ clinical judgment about what will work best for their individual patients. “No prescriber can predict which patients will become addicted to their opioid pain medication, so why take the chance if the patient’s pain can be managed without them?” Soin said.
Soin, who is vice chairman of the Ohio State Medical Board, said the three sets of guidelines cover all the major areas.
“Honestly, I think we should see how these work before issuing any more,” Dr. Soin said.
The next step is to educate doctors, dentists and other prescribers about the new guidelines.
Prescribers must now check the Ohio Automated Rx Reporting System — OARRS — before prescribing an opioid for more than a week. The guidelines encourage checking before writing shorter-term opioid prescription. OARRS keeps track of prescriptions issued statewide and can allow prescribers to detect “doctor shopping” by addicts seeking more medication and allow prescribers to better track what medications a patient is taking.
The number of doctor and pharmacist queries of OARRS was 9.3 million in 2014, up from 778,000 in 2010 and the incidents of individuals doctor shopping dropped to 960 in 2014, down from 3,100 in 2009. Ohio also saw a 5 percent decrease in the number of opioid doses dispensed in 2014 over 2012.