06-28-16 – NSMA Opioid Task Force
The NSMA Opioid Task Force met for almost two hours last evening. Thank you to Dr. Michael Lee from DOC and Dr. Bruce Witmer from ROC, who attended as representatives of NVOS.
In short, here are the takeaways:
- The First Lady and the Governor are very concerned/upset about the opioid epidemic and are looking for answers and action, not excuses.
- We are approaching this problem as a reaction to headlines; we need to talk about health instead.
- This will be one of the Governor’s legacy initiatives. Suggestions for action:
- Reduce supply
- Reduce doc shopping via regular use of the PDMP
- Provide (and have insurance pay for) more/better treatment options
- Involve law enforcement in some significant way in the way we practice medicine
- ID and weed out bad doctors – need self-policing model (suggestion to use term “Practice Management Protocol” instead of “self-policing”)
- Identify docs who are “outliers” in their prescribing patterns as Senator (Dr) Hardy attempted to do with SB114 last session (bill was watered down); would necessitate that licensing boards collect information on physician specialties
- Seek increased funding for mental health treatment
Discussion:
Catherine “Cat” O’Mara, CEO of NSMA, was asked to describe the tone of the recent 8-hour meeting called by the Governor to plan an “opioid summit” in August.
Cat said it is very clear that the Governor wants action. Later in the meeting, we discussed that this will be one of the Governor’s “legacy” initiatives; he is determined to take significant action that will impact the problem. The Governor exhibited visible frustration with the BME. He not-so-obliquely expressed frustration with certain groups that make excuses and fail to take action.
There has been a slight improvement in the opioid ‘epidemic’, with a reduction in opioid deaths both nationwide and in Nevada. However, in some areas (e.g. Nye County) where programs to reduce opioid use have been very successful, there has been a parallel increase in heroin use as a substitute. Nye County also discovered that PAs are often the prescriber, and often the physician was not fully aware of their PA’s prescribing practices. Also, there was mention of the recent news coverage of physicians being influenced by drug company “gifts.”
There was much discussion about CMEs; CA requires 8 related CMEs, Mississippi requires 5, and Nevada 2. Cat is researching best practices in all states and will report back. Richard Perkins, former City of Henderson Chief of Police, former Assemblyman/Speaker of the House, and current lobbyist for NSMA reminded everyone that NSMA worked to defeat an onerous CME requirement last session, so we’ll need to explain to legislators why it was not okay in 2015 but it is okay in 2017.
Dr. Frey said he’d like to have a reporting mechanism built into the PDMP system so that physicians can report outlier patients, but there is currently no such function and no one to whom these patients can be “reported” or referred.
The importance of physicians fully documenting their treatment plans, including verification that they checked the PDMP, was discussed as an important tactic. Also, it is important for physicians to consider multi-modal interventions, not just prescribing drugs. The challenge here is the limited alternatives – insurance companies that will not pay of alternate treatments, or the challenge of referring a patient and their options for receiving timely treatment.
Twice it was mentioned that insurance carriers – who will pay for opioids to a point – often will not cover clinical alternative treatment for pain or MAT for addiction. The physician community needs to focus on this (lack of) coverage and explore how carriers could/plan to address the issue. Cat has reached out to the health insurance association in the hopes of sparking some collaboration. Any statutory or regulatory changes will not affect ERISAs or self-insured plans, but would send a message.
The overall need for education – public health media campaigns, legislators, law enforcement, school-age children and early education — was discussed as tool to reduce use.
There was mention of holding more “take back” days, where “mountains” of prescription drug are collected by law enforcement. There are nuances here, as “mountains” of drugs could be construed as evidence of over-prescribing.
One doctor mentioned that when she asks patients where they get the opioids, they often answer that they bought them on the street. Where did the guy on the street get them? Apparently, elderly patients are cleaning out their medicine cabinets and selling their drugs to a middle man for extra income.
There was mention of a 7-day limit on opioid prescriptions. However, a physician who specializes in palliative/end of life care said that is not an option for her patients. As it is now, her terminal cancer patients have a difficult time refilling prescriptions because pharmacies refuse to refill. There must be some sort of carve-out for that population/specialty practice.
The next meeting is scheduled for 6:00 p.m., Monday, July 11.