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PSHP Legislative Ledger April 2016 - PA's response to the Opioid Epidemic

Monday, April 18, 2016   (0 Comments)
Posted by: Elizabeth Maynard
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What is going on in Pennsylvania to Stem the Prescription Drug Abuse Epidemic?

By: Christine Roussel 

On April 6, 2016, a few hundred pharmacists converged in the State Capitol on Harrisburg to support legislation related to the practice of pharmacy.  While the pharmacists had many topics they wanted to discuss with our legislators, on topic most government officials wanted to discuss with pharmacists was the prescription drug abuse epidemic.  Dr. Racheal Levine, the physician general for the state of Pennsylvania, and Mr. Jason Snyder, the Director of Communications for the Administration on Drug and Alcohol Abuse, both met separately with a large congregation of pharmacists from the Pennsylvania Pharmacist Association to discuss three different methods that the state is employing to reduce opioid abuse.

CDC Statistics (CDC.gov):

From 2000 to 2014 nearly half a million people died from drug overdoses.

Since 1999, the rate of overdose deaths involving opioids has nearly quadrupled.

78 Americans die every day from an opioid overdose.

The majority of drug overdose deaths (more than six out of ten) involve an opioid

 

 

Act 139 of 2014: Administration of Narcan (naloxone) 

Dr. Racheal Levine, the physician general for the state of Pennsylvania, signed a state wide standing order for the drug naloxone to reverse opioid overdoses as part of the Act 139 of 2014Administration of Narcan (naloxone).   Standing Order DOH-002-2016 is intended to ensure residents of Pennsylvania “ who are at risk of experiencing an opioid-related overdose, or who are family members, friends or other persons who are in a position to assist a person at risk of experiencing an opioid related overdoses as able to obtain Naloxone.”

This means that patients or a third party can obtain naloxone from a pharmacy if they are unable to obtain naloxone or a prescription for naloxone from a regular healthcare provider. 

The state has created and strongly advocates for its training program with regards to naloxone.  For more information visit the Pennsylvania Department of Drug and Alcohol Programs (DDAP) here

The Departments of Health, Education and Drug and Alcohol Programs started encouraging school administrators to start their own naloxone program back in September of 2015.  Adapt Pharma has been working with the Secretary of Health to assist High Schools across that state with obtaining two free doses of the intranasal formulation of naloxone.

Pennsylvania State Police as well as many local municipalities also carry the opioid overdose reversal aent, naloxone.

In 2014, 2500 people died in Pennsylvania from Opioid related deaths, which is more than the number of people who died in car accidents.

Per Dr. Racheal Levine, though difficult to track the use of naloxone in the state of Pennsylvania, over 750 opioid overdose reversal have been documented in the last 15 months.

 

One lingering question: What happens after a person has an overdose reversed, as technically the person has the right to get up and walk away.  Well the state has been advocating a “Warm Transfer” program to get these individuals moved direct into drug addiction support.  Governor Wolf pledged $7.5 million dollars in 2015-2016 to provide naloxone to police departments and provide better drug treatment programs to those suffering from opioid addiction.  Then this month, the PA Senate approved a resolution to create an advisory task force to on address issues relating to drug addiction treatment facilities in the state.  The need provide treatment for the disease of addiction cannot be understated, including access to facilities for the appropriate duration of time regardless of financial capabilities.  The treatment gap remains a large barrier to the reduction of opioid related deaths.

Prescription Drug Monitoring Program

To really an impact on opioid use, the practice of medicine is being called upon to employ more restrictive opioid prescribing and consider other options for acute and chronic pain control to curb the supply of excess prescription opioids.  The State of Pennsylvania has published Specialty Prescribing Guidelines that were written in conjunction with physician and pharmacy associations. 

 

Source: http://www.cdc.gov/vitalsigns/opioid-prescribing/infographic.html

The Pennsylvania Prescription Drug Monitoring Program (PDMP) is voluntary, but is strongly encouraged and is a very important step in the fight against the opioid abuse epidemic. 

Healthcare practitioners and Pharmacies (including mail order) that dispense controlled substances schedule II to V will electronically report prescription dispensing information.  It is important for this group to register with the Pennsylvania Prescription Drug Monitoring Program.  There are some exceptions including licenses healthcare facilities that are distribute controlled substances for administration in the licenses healthcare facility, hospice and veterinary use to name a few.

Prescribers, dispensers and designees of the prescriber will have access to electronically report and query the database. 

An Electronic PDMP is slated to go live this summer!

More details can be found hereState of Pennsylvania Prescribing Guidelines are available here

Current guidelines are available for the following professions: Dentistry, Podiatry, Emergency Medicine and Pharmacies.  Additional discipline specific guidelines are slated for release this year.

Drug Take Back Programs

In a study of 250 Patients receiving opioids after surgery (n=250), the average patient only consumed 1/3 of their total prescription.  This resulted in 4639 leftover pills of prescription painkillers creating a high potential for diversions.

Considering that study was a snapshot of a small group of patients,that leaves a significant amount of unused prescription opioids in the medicine cabinets, kitchens and bathrooms households in across Pennsylvania.  These unused opioids are  at risk for diversion through theft and subsequent abuse by children, friends, or neighbors or otherwise diverted, such as selling medication.

Per Mr. Jason Snyder, the Director of Communications for the Administration on Drug and Alcohol Abuse, In 2015, the Pennsylvania State prescription drug Take Back program removed 40,000 pounds of drugs from circulation, that was hauled away by the national guard.

A sample of drugs handed in by the public Prescription Drug Take Back Program, revealed that 25% of the drugs being returned were controlled substances.

It is important to for healthcare professions to discuss the availability and benefits of the Drug Take Back Programs with their patients!

References:

·        CDC.gov – Opioid Painkiller Prescribing information

·        Rogers et al. Opioid consumption following outpatient upper extremity surgery J Hand Surgical Medicine, 2012

·        https://www.pamedsoc.org/tools-you-can-use/topics/opioids

·        http://www.health.pa.gov/My%20Health/Diseases%20and%20Conditions/A-D/Pages/Act-139-of-2014.aspx#.VxDxMfPD_IU

·        PR Newswire – Physician General Racheal Levine Reminds Pennsylvania about the availability of Naloxone to Combat Drug Overdose, 3/16/16


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