• Prescription Drug Abuse Prevention: Senate Convenes Initiative, and Practitioners Express Concern
    Two US Senators, Joe Manchin (WV) and Tim Scott (SC) have announced the formation of the Senate Prescription Drug Abuse Caucus, with an invitation to their colleagues to participate. The initiative is another volley in the ongoing conundrum of how best to balance access and risk mitigation in the use of opioid analgesics for chronic pain. Daniel Bennett, MD, DABPM, a practicing interventional spine/pain medicine physician and CEO of the newly relaunched National Pain Foundation commented, “What pain doctors and patients worry about is whether this emphasis on one problem—prescription drug abuse—is being undertaken at the expense of millions of people who need these medications in order to combat their chronic pain, living life as normal as possible.” Other comments from pain practitioners have expressed the wish that the congressional initiative would spotlight the issue of chronic pain, rather than medication abuse. Senator Manchin, who has claimed that his state records the highest mortality rate from overdose deaths—29 people per 100,000—introduced the FDA Accountability for Public Safety Act earlier this year, which would make it more difficult for new and generic opioid drugs to be approved by the FDA. To read about methadone safety, click here. To read about opioid use during pregnancy, click here. To access a slide presentation on medication safety, click here. To read a news story about the new congressional initiative mentioned above, with links to related stories, click here.    
  • Minimize Rheumatoid Arthritis Costs and Intensive Treatments By Engaging Patients
    At PAINWeek 2014, patient engagement was termed the “blockbuster drug for pain” by faculty member Barbara Kornblau, JD, OTR/L, CPE, DASPE. Recent affirmation of the concept is provided by new research published in the journal Rheumatology reporting that patients with rheumatoid arthritis scored poorly in adherence to prescribing instructions for their biological medications. The UK-based study found that despite the proven effectiveness of new biologic drugs such as anti-TNF therapy, some 40% of patients fail to take the medications regularly as prescribed. The findings have prompted Arthritis Research UK’s head of health promotion to encourage people with arthritis to seek out further information and advice so that they are able to better understand the medication they have been prescribed, its positive benefits for their condition, and the reasons for taking it as directed. Among reasons cited by the researchers for this patient behavior were concern over potential side effects, a failure to appreciate the chronic nature of their illness, and a paucity of professional and/or family support. The team advocates a concentrated effort to inform, support, and engage patients more intensively, as a cost effective means to minimize the need for further intensive treatments and reduce unnecessary wastage of these expensive drugs. For more about patient engagement: For an interview with Barbara Kornblau, mentioned above, click here. To read about a patient engagement and provider communication study of opioid therapy, click here. For more about rheumatoid arthritis, click here. Read more on the research findings discussed above, with link to the source article, here.  
  • Prescribing Opioids: Initiative Includes New Guidelines for Clinicians
    Last week, the Massachusetts Medical Society announced that it is launching a comprehensive campaign to educate physicians and patients about safe prescribing and the storage and disposal of prescription pain medications. The campaign will be comprised of 3 elements: 1) guidelines for prescribers to help them make the right decisions for their patients; 2) free educational resources for prescribers to help inform their judgments; 3) information on the critical aspects of storage and disposal of prescription drugs for patients and families. The organization spokesperson emphasized that the new guidelines are not designed to micromanage, but to improve patient care and lessen the risks associated with opioid prescribing. The Massachusetts Medical Society, with more than 24,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. In announcing this patient/prescriber educational initiative, the Society referenced the current public health crisis of opioid abuse, misuse, and diversion, and cited a recent poll by the Harvard School of Public Health that discovered that nearly 4 in 10 Massachusetts residents personally know someone who has abused prescription pain medications. View additional content about safe opioid prescribing here. To read more about opioid abuse, click here. What would a world without opioids look like? Read what Dr. Charles Argoff has to say, here. Read about why primary care physicians are prescribing fewer opioids, here. Read a news release from the Massachusetts Medical Society, with link to the guidelines, here.
  • Combating Occurrence & Costs of Neonatal Abstinence Syndrome
    A report in the March/April issue of the Journal of Addiction Medicine finds that the costs of treatment for babies with neonatal abstinence syndrome (NAS)—symptoms and complications related to withdrawal from the opioid pain medication to which they were exposed in utero—have increased dramatically as more infants are born to mothers with dependence on prescription pain medications. The authors cite the findings in support of their recommendations for more intensive screening of pregnant women for substance abuse. The report contends that nonmedical use of prescription opioid pain medications during pregnancy has increased 5-fold since the late 1990s. Some infants born to women with opioid use disorder will develop NAS. Although universal screening for drug use during pregnancy has been recommended by major specialty organizations, it is not yet standard practice, according to the authors. They also call for studies to improve the management of NAS and for follow up of evidence that buprenorphine may lead to better treatment outcomes, in comparison to methadone, in the treatment of pregnant women with opioid use disorder. View related content here. Read more about the research and recommendations, with link to the journal article, here.        
Daniel Carr, MD, FABPM
Pain Research, Education, and Policy Program
Department of Public Health and Community Medicine
Tufts Medical Center
Boston, MA


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