Are We Making Progress?
Christopher T. Dietrich, MD
SDSMA President

 

As I assume the South Dakota State Medical Association baton for this next year, I hope to continue the work that many great past presidents and policy councils have performed. Along with our Board of Directors and Policy Council, we hope to continue to advocate for patients and physicians in South Dakota. 
   
One of our recent projects has involved working with the South Dakota Department of Health implementing a program and utilizing a grant to provide education regarding responsible opiate prescribing. This also includes education regarding medication assisted treatment.

SDSMA has been working diligently to provide education to our members and other prescribers in our state. We have been traveling around the state and presenting at numerous conferences and meetings. In addition to educating physicians we are leading the charge reaching out to law enforcement, hospital administrators, dentists, and ancillary health providers. Coming this month, the SDSMA is beginning the first of six webinars addressing responsible opiate prescribing education. Visit www.sdsma.org to register for the webinars.

6:30 p.m. CT June 19, 2018 - Opioids - Diversion, Addiction and Treatment 
4:30 p.m. CT June 26, 2018 - Understanding Drug Diversion and How to Combat It
4:30 p.m. CT July 10, 2018 – Understanding Addiction and Its Impact on the Brain
TBD – Drug Addiction and Pregnancy
TBD – Safe and Effective Tapering of Opioids
TBD – Beyond MAT

In recognition of the fact that prescription drug monitoring and drug disposal programs alone will not eliminate the availability of drugs for abuse or diversion, this educational series for prescribers is aimed at decreasing abuse, diversion and addiction through the promotion of appropriate prescribing patterns, patient management, drug diversion and abuse detection, and patient referral for treatment.  

While we are working hard to decrease the total number of pills in our communities and to lower the total morphine milligram equivalents (MMEs) prescribed, there remains the ultimate question. Are we gaining ground and seeing improvement? Recent data from the South Dakota Prescription Drug Monitoring Program shows a decrease from 259,700 controlled substances prescribed in 2016 to 234,367 in 2017. Likewise, hydrocodone prescriptions have decreased from 17.4 million doses in 2016 to 14.9 million doses in 2017. There have also been concerted efforts to remove unused prescriptions from our communities as take back programs at local law enforcement agencies, clinic disposal containers, and pharmacy collection receptacles become more prevalent. While these are significant improvements, we continue to have much work to do.

Future directions will address acute prescribing. Specifically trying to limit acute opiate scripts to seven days or less. Recent studies suggest acute prescriptions longer than this place individuals at increased risk for addiction and dependence. Additional directions will need to focus on the use of benzodiazepines. These have accounted for 246,054 prescriptions in 2017 for a total of over 14 million pills.

Earlier this month the American Society of Addiction Medicine held a Treatment of Opioid Disorder Course in Sioux Falls. The course covered the highest quality, evidence-based practices for treating patients with opioid use disorder. This course covered all medications and treatments for opioid use disorder, and provided the required education needed to obtain the waiver to prescribe buprenorphine.

As we move forward the challenge continues to be balancing the need to adequately treat patients and their pain with safe opiate stewardship.

Resources
1. Drug Enforcement Administration Diversion Control Program, www.DEAdiversion.usdoj.gov
2. PainLaw.org, www.painlaw.org
3. Risk reduction strategies (free online CME), www.opioidprescribing.com
4. Opiate Analgesics for Chronic, Non-Cancer Pain: Recommendations from the Committee on Pain Management and Prescription Drug Abuse, www.sdsma.org 
5. Calculating Total Daily Dose of POpioids for Safer Dosage, www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf
6. Standards for Medical Records When Prescribing Controlled Substances for the Treatment of Chronic, Non-Cancer Pain, South Dakota Codified Law, www.sdsma.org
7. https://www.regonline.com/registration/Checkin.aspx?EventID=2341411