Issue link: http://viewer.e-digitaledition.com/i/643923
0 6 A S PA RT OF Ohio's continu- ing eŸort to curb the misuse and abuse of prescription pain medications and unintentional over do s e s , t he G over nor 's Cabinet Opiate Action Team has issued new opioid prescrib- ing guidelines for the treatment of patients with acute (short- ter m) pa in. Acute pa in ca n result from injuries, or surgical a nd denta l procedures, a nd is genera lly resolved within 12 weeks. The new acute g uidelines expand upon Ohio's existing prescribing and treatment g uidelines issued in 2012 and 2013. A ll three were developed by the Governor's Cabinet Opiate Action Team in conjunction with clinical professionals associations, healthcare providers, state licensing boards and state agencies. None of these guidelines are intended to replace clinical judgment. In 2014, more than 262 million opioid doses were dispensed in Ohio for the management of acute pain — 35 percent of the state's 750 million total dispensed opioid doses. Prescription opioids remain a significant contributor to unintentional drug overdose deaths in Ohio, contributing to nearly one-half of all deaths in 2014. The new guidelines urge prescribers to first consider non- opioid therapies and pain medications — when appropriate — for the outpatient management of acute pain. This approach can help to prevent the potential misuse and abuse of left- over opioids. "No prescriber can predict which patients will become addicted to their opioid pain medication, so why take the chance if the patient's acute pain can be managed by less dangerous treatment options?" says Dr. Amol Soin, a pain management specialist and Vice President of the State Medical Board of Ohio. When opioid medications are necessary to manage a patient's acute pain, the g uidelines recommend that the clinician prescribe the minimum quantity necessary without auto- matic refills. "Prescribing only the amount necessary — based on each individual patient's needs — will help reduce the number of leftover, unused opioids and the potential for diversion and abuse," says Dr. Soin. He also notes that, like the chronic pain prescribing guide- lines issued in 2012 and 2013, the new acute pain guidelines call for prescribers to check the State Board of Pharmacy's Ohio Automated Rx Reporting System (OARRS) before prescribing an opioid. A review of OARRS is required for most opioid and benzodiazepine prescriptions of seven days or longer. To ma ke access to OA R R S ea sier, G ov. Joh n K a sich announced last October an investment of up to $1.5 million per year to integrate OARRS directly into electronic medical records and pharmacy dispensing systems across Ohio. More than 110 hospitals, pharmacies and physician o«ces already have requested integration. Ohio's opioid prescribing guidelines are having a positive impact in the fight against prescription drug abuse: + The number of prescriber and pharmacist queries using OA R RS increased from 778,000 in 2010 to 9.3 million in 2014. + The number of individuals "doctor shopping" for controlled medications decreased from more than 3,100 in 2009 to approximately 960 in 2014. + The number of opioid doses dispensed to Ohio patients decreased by a lmost 42 million from 2012 to 2014. + The number of patients prescribed opioid doses higher than chronic pain guidelines recommend to ensure patient safety decreased by 11 percent from the last quarter of 2013 to the second quarter of 2015. + Ohio patients receiving prescriptions for opioids and ben- zodiazepine sedatives at the same time dropped 8 percent from the last quarter of 2013 to the second quarter of 2015. Copies of a ll three opioid prescribing g uidelines, a long with tools a nd resources for prescribers, a re ava ilable at opioidprescribing.ohio.gov. ■ BY CHRISTOPHER M. HURYN BY CHRISTOPHER M. HURYN New Opioid Prescribing Guidelines ❱❱❱❱❱ F R O M T H E S TA T E M E D I C A L B O A R D O F O H I O Ohio Issues for Acute Pain