Medical Board tries to tame overuse, overprescription of painkillers

Tue Mar 18 21:49:51 PDT 2014

February 25, 2014

Medical Board tries to tame overuse, overprescription of painkillers

Sacramento Business Journal

By Kathy Robertson

The biggest drug problem in the U.S. is in the home medicine a cabinet, and theMedical Board of California is trying to change that.

Nearly 7 million Americans are abusing prescription painkillers, more than the number of people using cocaine and heroin combined, federal statistics from 2012 show. And that figure had jumped 80 percent in six years.

After consumers mobbed a March 2013 legislative hearing with complaints about California doctors who overprescribe opiates for pain, the state agency that oversees doctors created a prescribing task force to address the problem.

An initial meeting was held in September. A second meeting, held last week, looked at Canadian guidelines and a model policy by the Federation of State Medical Boards. The plan is to draft new California guidelines and get board approval for them this fall.

The issue is to address the need for legitimate pain relief for those who suffer from chronic pain but stem over prescription of narcotics.

The model policy points to inadequate initial assessments that overlook the risks involved, inadequate monitoring, inadequate patient education and consent, unjustified dose escalation, excessive reliance on opioids and inadequate use of available tools to check for over prescription or overuse of these drugs.

“We went through each of the items and what’s in our document, which we want to make more robust,” Medical Board Executive Director Kim Kirchmeyer said.

The task force got only half way through the model plan, she said. Additional meetings will be held.

“Bottom line: we have to have a policy statewide in how we use these medications,” said Dr. Scott Fishman, a pain management specialist at UC Davis who appeared before the task force Feb. 19 to explain the model policy by the Federation of State Medical Boards. “It’s a matter of weighing benefits versus the risk.”

The policy was revised in August to put more emphasis on potential risks of opioid therapy, the need for informed consent, and the need for evaluation and risk assessment before and after prescribing this kind of drug, Fishman added.

There also has been a big shift in regulation in the last six months toward a more cautious approach to opioid use, Fishman said.

The U.S. Food and Drug Administration has issued new labeling requirements that acknowledge that opioids pose serious risks. The FDA also called for increased monitoring and better patient education.

“It’s judgment on individual-based risk and getting away from a cookie cutter approach to pain,” Fishman said.

Bryan Sloane
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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