By Brian Irwin
By now, many of you are well aware that we have an opiate crisis in the state of New Hampshire. Overdoses from opiates or the combination of opiates and other medications are rising at staggering rates. Fatalities are becoming more and more common, as is addiction. We are seeing this penetrating all socioeconomic stratas, as well as all age groups. In response to this crisis, the New Hampshire Board of Medicine has passed new rules for the responsible prescribing of opiates. These rules went into effect on Jan. 1, 2017, and impact not only providers, but patients who take opiates.
So what's changed? The rules are deep and complex but in essence there are now expectations that prescribers must meet to comply. These include a documented history and physical, the use of a board-approved tool to determine the risks to patients taking opiates (these are not risk-free medications) and documentation of the rationale behind the prescription.
The rules go deeper, however. These include a treatment plan that considers non-opiate options, an informed consent document that outlines the risks and benefits of the opiate, and a mandatory inquiry into the N.H. Prescription Drug Monitoring Program. This program allows providers to see every single prescription that patients fill in New Hampshire as well as many other states.
These rules apply to all patients, even those taking opiates for a very short period of time — for example, for trauma or injury. For those taking opiates on an acute basis, a re-evaluation is mandatory if pain persists beyond 30 days. For those on chronic opiates, the rules also mandate a written treatment agreement that includes details on safe storage and disposal of medications, consent to random drug testing to ensure compliance and a requirement to only accept opiates from a single provider.
Chronic pain patients are handled differently than acute patients. This subgroup must be evaluated by the prescriber for referral to a pain clinic if the patient receives 100mg or more of morphine equivalent daily for a period of time greater than 90 days. Likewise, referral to a pain clinic is encouraged for those with a high risk for abuse or addiction or those with a co-morbid psychiatric disorder. The N.H. Prescription Drug Monitoring Program must be queried at least twice a year, and random urine drug testing is required at least annually.
These changes carry a degree of burden; however, it's the ongoing crisis in our state that has led to the implementation of these changes. Dealing with any epidemic, including an opiate epidemic, requires the community to pull together. While there may be a host of medical providers in this region, we all must work in a collaborative fashion to help stop this very dangerous pattern that is literally killing our children, our family members and our friends.
If you're on opiates, it may be worth discussing these changes with your provider as they affect us all, from providers who prescribe pain medications, to those patients who utilize them. Some may find these new rules frustrating or time consuming, but please realize the goal is to save lives. By working together in this community, we can all strive for a safer atmosphere for everyone in our town. And beyond.
Dr. Brian Irwin is a family physician at Tamworth Family Medicine, a division of Huggins Hospital.
- Category: Health