Final Word: Prescription drug abuse survey presents opportunities to reduce the opioid crisis
Katie Lozano, MD, FACR, CMS Immediate Past President
As you may know, I designated the opioid epidemic as one of the top priorities of my CMS presidency last year, continuing the momentum and commitment of CMS over the past five years to address this issue. I was encouraged by the results of the recently released survey – Prescription Drug Abuse: The Physician’s Perspective – featured on page 24, that shows that many of us have responded proactively to this public health threat by recognizing the urgency of the situation, educating ourselves on safe opioid prescribing, checking the PDMP on a regular basis, incorporating patient safety counseling and limiting opioid prescriptions. We still have a long way to go, though, and I hope all CMS members will read the survey results and consider how we can work together to make further gains to benefit our patients.
One point physicians should seriously discuss is the fact that the most common start to nonmedical use and addiction is the result of unused prescription opioids obtained free from friends or relatives. Experts have labeled this phenomenon the “medicine cabinet” problem. Physicians overprescribe and do not properly counsel patients; opioids are not properly stored during or after a course of care and are then used by the patient after legitimate pain has subsided or are stolen by people in the home and given to friends and neighbors, thus creating the cycle of misuse, abuse and addiction.
There were 912 Colorado drug overdose deaths in 2016 and 504 of these were opioid involved. Virtually every member of the General Assembly has a personal story directly related to the “medicine cabinet” problem. Our own survey supports their stories – 67 percent of respondents say they are “concerned about physicians who overprescribe opioids for patients with legitimate pain” and 62 percent are “concerned that physicians are overprescribing opioids for patients who do not have legitimate pain.”
The executive and legislative branches of Colorado state government are fully engaged on the opioid epidemic. Lt. Gov. Donna Lynne, on behalf of Gov. John Hickenlooper, has brought CMS leaders in for private meetings on the opioid crisis three separate times in the last seven months. And the bipartisan Opioid and Other Substance Use Disorders Interim Study Committee established by the 2017 General Assembly has completed its work on recommendations for legislation relating to opioid and other substance abuse disorders.
The message to us from the governor and members of the interim committee has been crystal clear – they are grateful for the hard work of CMS on the opioid crisis over the last five years and ask physicians to continue to step up with other stakeholders to do even more to protect the public.
The interim committee and the governor will work to enact legislation in 2018 to enact opioid prescription fill limits and mandatory PDMP checks. CMS has already agreed to suspend our long-standing policy in opposition to statutory limits on prescription fills and PDMP checks. Because these elected officials understand that the epidemic is multifaceted, that future progress will require a multi-pronged approach, and that physicians are partners working with them to address the epidemic, they are open to exceptions and time-limiting these statutes to two years. At the end of this two-year period, we will need to demonstrate that our profession has been working together to address issues under our control or else expect the 2021 General Assembly to take action. I am confident we can continue to make a difference. The lives of our patients and their families depend on it.