Archives     Advertise     Editorial Calendar     Subscribe     Contact Us    


Taking the Bull by the Horns


 
Nita W. Shumaker, MD

TMA Looks at Strategies to Curb the Opioid Crisis

The national opioid epidemic is a multifactorial problem that will require cross-disciplinary interventions to move the needle on addiction. Tennessee Medical Association President Nita W. Shumaker, MD, has made it a priority to work with providers across the state to ensure physicians are a key part of that solution.

"We are, by some accounts, number two in the nation in the number of opioids that are prescribed," Shumaker stated.

Certainly there is plenty of blame to go around as to why opioid use has dramatically increased over the past three decades. Recently, a number of states have sued pharmaceutical companies alleging deceptive marketing practices that encourage overprescribing. Shumaker and others also point to a 1980 letter that appeared in the New England Journal of Medicine citing only a 1 percent addiction rate for those receiving opioids in acute pain situations in an inpatient setting.

A recent analysis (NEJM, June 1, 2017) on the impact of that correspondence found the letter has been cited in more than 600 articles with the vast majority of authors using it as 'evidence' of opioid safety. In addition, 80.8 percent of those articles neglected to mention the patients referenced in the original letter were hospitalized when receiving the drugs for acute, rather than chronic, pain.

No matter how the nation got to this point, Shumaker said it's critical to implement changes to reverse the trajectory of addiction and overdose deaths. Several measures have been implemented over the last few years including mandatory opioid prescribing education for physicians in order to maintain licensure.

"We've already made good choices on the back end," Shumaker said of efforts by organized medicine that include identifying high prescribers, broadening education, and closing down pill mills. "The Tennessee Medical Association's particular focus this year is on frontend prescribing," she continued.

Shumaker said TMA is working in partnership with state health and substance abuse experts, Tennessee Nurses Association, Tennessee Hospital Association, Tennessee Pharmacy Association, the Dental Board, addiction specialists, legislators and opioid task force members across the state to document and share what's already being done. "Many people are doing good things, but they are all operating in silos," she noted. "My hope would be that once we document successful programs and what makes the biggest impact, that we share with others in the state."

Shumaker added, "My particular focus as TMA president this year is to work with the large medical centers and academic centers to start drilling down on their own data." She added the goal is to use data and peer comparisons to better understand optimal dosing and duration following various procedures to establish guidance, recognizing medical judgment might dictate different directions based on an individual's specific profile.

Citing a recent study in The Journal of Pain that followed patients prescribed opioids after orthopedic surgery, Shumaker noted, "The average patient was prescribed 80 pills, and the mean number of days they took the opioids was seven. Of patients who reported completing their therapy, as many as 85 percent of them said they had unused pills remaining."

Shumaker added the study found only 16 percent said they knew how to store the drugs safely, and just 11 percent locked them up. "Only 22 percent knew how to dispose of the drug, but ... here's the kicker ... only 4 percent actually did."

In addition, Shumaker is promoting the TMA's Stop, Drop and Roll campaign for primary care providers. "When a new patient comes in with lower back pain, you stop and don't prescribe an opioid for a chronic issue and talk to them about other modality options," she said. "The drop is for those who already are on opioid medications that you have a plan over six months or an appropriate time to decrease the amount/dosage of opioids they are on and introduce other paint management methods."

"The roll is because there are going to be some people who you can't drop their dosage, or it becomes clear they have addiction issues," Shumaker continued. "They need to be rolled to paint management or addiction specialists as appropriate."

She noted that by prescribing less medication after procedures and lessening the number of prescriptions started, Tennessee physicians could be leaders in shifting the culture in the state. "Those two measures alone will make a huge change in how many new people become addicted to opioids," she said.

"We want to support our physicians and give them the tools and the data so we understand how we compare to our peer group and work together to establish best practices to decrease opioid use in the management of chronic pain and take better care of our patients," Shumaker concluded.

WEB:
TMA
Tennessee Chronic Pain Guidelines
Tennessee Dept. of Mental Health & Substance Abuse Services

 
Share:

Related Articles:


Recent Articles

The 2019 Legislative Agenda

A new governor and many new legislators make 2019 a learning year as the state's top healthcare organizations seek to address a number of old issues and tweak some new solutions unveiled last year.

Read More

Updated Cholesterol Guidelines Take a Personalized Approach

The American Heart Association and American College of Cardiology released updated cholesterol clinical guidelines in November 2018, taking a more nuanced approach to care over a patient's lifetime.

Read More

Sharing Data, Saving Lives

In an increasingly connected medical ecosystem where patient safety, health status improvement, and provider reimbursement are impacted at every point along the continuum, the need to efficiently, securely share data appears to have reached a tipping point.

Read More

New Rules in Heart Disease

A number of guideline changes and updates warrant more education around statin use and blood pressure monitoring, but local cardiologists say the higher standards are a game changer.

Read More

Dr. Ashish Shah: A Heart for Transplant Patients

Dr. Ashish Shah is the driving force behind the growth and innovation at one of the nation's busiest heart transplant programs.

Read More

Heart Monitor

Cardiovascular news of note.

Read More

ECMO Program Thriving at TriStar Centennial

A TriStar Centennial, a team approach is key to hospital's successful ECMO program.

Read More

Alexander Looks for Innovation, Asks Council Fellows for Input

Sen. Lamar Alexander asks stakeholders and future leaders to weigh in on ways to improve health outcomes, lower costs.

Read More

CMS Utilizes Dartboard Approach to Modernizing the Medicare Drug Benefit

Controlling pharmaceutical prices remains a hot topic, judging from the 6,415 comments received in response to the CMS proposed rule: "Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses."

Read More

A Conversation with LHC Director Molly Vice

Every company should have a succession plan. LHC plays a key role in planning for the next generation of leaders for an entire industry.

Read More

Email Print
 
 

 

 


Tags:
Addiction, Nita Shumaker, Opioid Epidemic, Opioids, Overprescribing, Pain Management, Tennessee Medical Association, TMA
Powered by Bondware
News Publishing Software

The browser you are using is outdated!

You may not be getting all you can out of your browsing experience
and may be open to security risks!

Consider upgrading to the latest version of your browser or choose on below: