The number of visits to hospital emergency rooms related to the misuse or abuse of pharmaceuticals rose dramatically during the latter part of the last decade. Between 2004 through 2011, the numbers rose 16% per year growing from 626,000 to over 1.4 million. A 2011 report from the Centers for Disease Control showed that Pennsylvania ranks among the 12 states with the highest death rates with prescription opiate overdoses. Pennsylvania drug-induced deaths (15.7 per 100,000 population) exceeded the national rate (12.8 per 100,000). On December 3, 2014, the Pennsylvania Joint State Government Commission published a report “Guidelines for Prescribing Opioid Analgesics” which contains the Advisory Committee’s recommendation on prescribing guidelines for Pennsylvania. Some of the guidelines are as follows:
- Before initiating chronic opioid therapy, clinicians should conduct and document a history, including documentation and verification of current medications, and a physical examination.
- The initial evaluation should include the documentation of the patient’s psychiatric status and substance use history. Clinician should consider using a valid screening tool to determine the patient’s risk for advert drug-related behavior.
· Opiates should rarely be used as a sole treatment modality.
· The provider should discuss the risk and potential benefits associated with treatment, so that the patient can make an informed decision regarding treatment.
· Caution should be used in patients also taking benzodiazepines, as the use of benzodiazepines in addition to chronic opioid therapy increases the risk of serious adverse events.
· Patients with co-existing psychiatric disorder(s) may be at increased risk of harm related to chronic opioid therapy.
· The risk of cognitive impairment is increased when opioids are taken with other centrally acting sedatives, including alcohol and benzodiazepines.
· Total daily opioid dosage above 100 mg/day of oral morphine or its equivalent (80 mg of oxycodone) is not associated with improved pain control, but is associated with a significant increase in risk of harm.
It is essential that a physician follow protocol and keep accurate patient records.
In the past few years, I have seen a dramatic increase in the number of physicians prescribing opiates who have come under investigation and prosecution by the DEA. In other cases where a physician is not charged criminally, the physician is being prosecuted by the Medical Board.
If you are contacted by a law enforcement agency or the State Medical Board, do not speak with anyone until you contact a skilled criminal and licensing attorney. I am available to discuss both the criminal and licensing aspects of your case.
