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chronic pain: tools and resources

 

RISK EVALUATION AND MITIGATION STRATEGY FOR ER/LA OPIOIDS

The Food and Drug Administration released a Risk Evaluation and Mitigation Strategy (REMS)for extended-release/long-acting opioids in 2012.  The REMS includes continuing education for clinicians/prescribers, patient safety education, resources for storage and disposal, and use of prescription drug monitoring programs.  The REMS is also supported by the DEA and White House.
 

CAFP is a founding partner, with 12 other organizations, of the Collaborative for REMS/Relevant Education (CO*RE).  CO*RE has been working since 2010 to address the REMS and broader topics of prescription use and abuse, producing a wide array of educational activities, tools, resources and links to more information.

 

MAINTENANCE OF CERTIFICATION – CHRONIC PAIN

Continuing medical education and professional development to address the management of chronic pain, including, but not limited to, the use of opioids, is one very important means to improve patient care.  The Interstate Postgraduate Medical Association (IPMA) has developed an MOC Part IV module, approved for American Board of Family Medicine Part IV MC-FP credit.  It is an online, team- and evidence-based approach to improving your care of chronic pain patients.

 

HHS ANNOUNCES NEW ACTIONS TO COMBAT OPIOID EPIDEMIC

U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell announced on July 6, 2016, several new actions the department is taking to combat the nation’s opioid epidemic.

The actions include expanding access to buprenorphine, a medication to treat opioid use disorder, a proposal to eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions, and a requirement for Indian Health Service prescribers and pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain. In addition, the department is launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to improve and expand prescriber education and training programs.

“The opioid epidemic is one of the most pressing public health issues in the United States. More Americans now die from drug overdoses than car crashes, and these overdoses have hit families from every walk of life and across our entire nation,” said Secretary Burwell. “At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention. These actions build on this approach. However, if we truly want to turn the tide on this epidemic, Congress should approve the President’s $1.1 billion budget request for this work.”

The actions announced build on the HHS Opioid Initiative, which was launched in March 2015 and is focused on three key priorities: 1) improving opioid prescribing practices; 2) expanding access to medication-assisted treatment (MAT) for opioid use disorder; and 3) increasing the use of naloxone to reverse opioid overdoses. They also build on the National Pain Strategy , the federal government’s first coordinated plan to reduce the burden of chronic pain in the U.S.

Buprenorphine Final Rule:  Expanding access to MAT is one of the three foundational priorities of the HHS Opioid Initiative, and buprenorphine is one of the drugs frequently used for MAT.  The rule finalized on July 6, 2016 by the Substance Abuse and Mental Health Services Administration (SAMHSA) allows practitioners who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients.  Practitioners are eligible to obtain the waiver if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting as described in the rule.

HCAHPS Proposal:  Many clinicians report feeling pressure to overprescribe opioids because scores on the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey pain management questions are tied to Medicare payments to hospitals.  But those payments currently have a very limited connection to the pain management questions on the HCAHPS survey.  In order to mitigate even the perception that there is financial pressure to overprescribe opioids, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital payment scoring calculation. This means that hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive.

IHS PDMP Policy:  While many Indian Health Service (IHS) clinicians already utilize PDMP databases, IHS will now require its opioid prescribers and pharmacists to check their state PDMP database prior to prescribing or dispensing any opioid for more than seven days.  The new policy is effective immediately for more than 1,200 IHS clinicians working in IHS federally operated facilities who are authorized to prescribe opioids.  Checking a PDMP database before prescribing an opioid helps to improve appropriate pain management care, identify patients who may have an opioid misuse problem, and prevent diversion of drugs. This policy builds on IHS efforts to reduce the health consequences associated with opioid use disorder. As a part of this work, IHS announced that it would train hundreds of Bureau of Indian Affairs law enforcement officers on how to use naloxone, and provide them with the life-saving, opioid overdose-reversing drug.

New Research Priorities:  Research on opioids, conducted and funded by HHS, helps the department better track and understand the epidemic, support the development of new pain and addiction treatments, identify evidence-based clinical practices to advance pain management, reduce opioid misuse and overdose and improve opioid use disorder treatment – all areas of research that are critical to our national response to the opioid epidemic. HHS will launch more than a dozen new scientific studies on opioid misuse and pain treatment to help fill knowledge gaps and further improve our ability to fight this epidemic. As part of this announcement, the department released a report and inventory on the opioid misuse and pain treatment research being conducted or funded by its agencies in order to provide policy-makers, researchers, and other stakeholders with the full scope of HHS activities in this area. The report will also help these stakeholders and external funders of research avoid unnecessarily duplicating research that is currently underway. For more information, download the HHS infographic on the department’s research priorities.

Prescriber Training RFI:  HHS is actively working to stem the overprescribing of opioids in a number of ways, including by providing prescribers with access to the tools and education they need to make informed decisions.  In particular, HHS has developed a number of activities that support opioid prescriber education.  This request for information seeks comment on current HHS prescriber education and training programs and proposals that would augment ongoing HHS activities.

For more information on other actions HHS has taken to address the opioid epidemic, download the department’s new Opioid Epidemic fact sheet.

 

ARTICLES AND LINKS

SAMSHA (The Substance Abuse and Mental Health Services Administration), an agency within the U.S. Department of Health and Human Services, led public health efforts to advance the behavioral health of the nation, including reduction of substance abuse and mental illness:

 

Use of Opioids for the Treatment of Chronic Pain (American Academy of Pain Medicine)

 

Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies (NEJM)

 

Opioids for Chronic Pain: First Do No Harm (Annals of Family Medicine)

 

Opioids and Chronic Pain (NIH Medline Plus)

 

I am a Doctor, but I Didn't Cause the Opioid Epidemic (KevinMD)