As accidental overdose deaths spike in Ohio, Gov. John Kasich, lawmakers and regulators on Thursday announced new limits on prescribing powerful painkillers for acute pain, such as after surgeries or injuries.
The governor’s plan will allow for 7 days worth of opiates for adults and 5 days for children when the drugs are prescribed for acute pain. There will also be limits on the total morphine equivalent dose that is doled out and prescribers will be required to report diagnoses when opiates are prescribed.
“We have made progress, make no mistake, but the progress isn’t enough,” Kasich said Thursday at a press conference with regulators from state boards that govern doctors, dentists, nurses and pharmacists. Kasich said the state regulatory boards will mandate the new rules — 14 months after such guidelines were recommended in January 2016.
Dr. Amol Soin, chair of the state Medical Board of Ohio and a pain specialist practicing in the Miami Valley, said rules instead of guidelines can be more effective.
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“We are talking about acute injury or new injuries. Obviously, chronic and long-term pain — different set of rules and guidelines entirely. But for this instance I think it’s good because after seven days, if the patient still has pain, you can re-assess,” Dr. Soin said.
Giving medical professionals guidelines for prescribing opiates is not a new strategy. In April 2012, Kasich’s Opiate Action Team issued guidance for emergency rooms and acute care facilities. In October 2013, guidelines were fired off for chronic pain management clinics. In January 2016, recommendations were made to doctors treating acute pain.
And in January 2017, Kasich signed into law a measure that requires Ohio’s 42,000 pharmacy technicians to register with the Ohio Board of Pharmacy and that limits opiate prescriptions to a 90-day supply.
Prescribers must check Ohio Automated Rx Reporting System — OARRS — before prescribing an opioid for more than a week. 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 system, first established in 2006, shows a decline in the number of patients receiving opiates, the number of doses prescribed and the number of doctor shoppers in the last few years.
Despite investing almost $1 billion a year to fight drug abuse and addiction, accidental overdoses claimed 3,050 lives in Ohio in 2015, up 20.5 percent over 2014.
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Nationwide, opioids — both prescribed and illegal, such as heroin — have fueled an alarming rise in deadly drug overdoses. In 2015, there were 33,091 deaths — four times more than in 1999, according to the Centers for Disease Control and Prevention. The five states with the highest rates of drug overdose deaths: West Virginia, New Hampshire, Kentucky, Ohio and Rhode Island.
Kasich has been fighting to preserve expanded Medicaid, made possible through the Affordable Care Act, which provides funding for drug treatment and mental health services.
Roughly 30 percent of the 700,000 Ohioans covered under expanded Medicaid have substance abuse issues and 30 percent require mental health services, said Tracy Plouck, director of the Ohio Department of Mental Health and Addiction Services.
Plouck said Ohio will soon receive an additional $26 million for drug treatment and prevention services through a federal law signed by Barack Obama in December. Counties hardest hit but the opiate addiction crisis will get priority for that funding, including Butler, Clark, Greene, Montgomery and Warren counties.
Kasich said he doesn’t believe that medical marijuana will play any role in the opiate addiction crisis.
“I don’t like the whole thing with medical marijuana,” the governor said. Telling kids not to do drugs but then indicating marijuana can be used as medicine sends mixed signals, he said.
Dr. Soin, who serves on the Ohio Medical Marijuana Advisory Committee, said there isn’t enough data to determine whether medical marijuana could lead to reductions in the number of Ohioans taking prescription painkillers.
“I don’t know yet but I am too concerned about introducing another drug or de-stigmatizing a drug that is dangerous or could be a gateway drug to children,” Dr. Soin said.
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