Should doctors co-prescribe anti-overdose drugs with opioids?

Would co-prescriptions help fight opioid abuse?
Should doctors co-prescribe anti-overdose drugs with opioids?
Posted at 1:50 PM, Jun 10, 2018
and last updated 2018-06-10 14:13:54-04

COLUMBUS, Ohio (AP) -- Doctors prescribing painkillers to patients with chronic pain should be required to also provide them with prescriptions for anti-overdose drugs, several people and organizations told the state medical board as it reviews ways to slow the opioid crisis.

Under current rules, doctors must prescribe opioids like Vicodin or Percocet for chronic pain in a way that prevents the drugs' misuse. But those rules don't spell out safety steps doctors should take as doses increase.

The medical board is proposing to tighten rules for chronic pain prescribing, such as requiring that patients meet with a pain management specialist when drugs hit higher doses. The Associated Press obtained public comments to the medical board on the rules through a records request.

The proposals govern patients experiencing chronic pain associated with cancer, rheumatoid arthritis, multiple sclerosis and other illnesses. The rules wouldn't apply to patients who are dying.

Republican Gov. John Kasich has pushed prescribing limits in recent years to battle the addiction crisis, which led to a record 4,050 overdose deaths in Ohio in 2016, a number expected to jump even higher when 2017 data are available.

As in many states, the epidemic began with rampant abuse of prescription painkillers. Today, most overdose deaths in Ohio involve illegal use of opioids like fentanyl and heroin. Still, one in five people who died of a fatal overdose in 2016 in Ohio had had a painkiller prescription in the past month.

The rules proposed by Kasich last month also require that doctors offer the overdose antidote drug naloxone to those patients, a practice known as "co-prescribing."

That doesn't go far enough, especially at a time thousands are dying in the state from overdoses, according to the public comments obtained by the AP.

"I'm in favor of co-prescription as a way to ensure chronic pain patients are able to receive the treatment they need, while also putting safeguards against fatal overdose," Dr. Anahi Ortiz, the Franklin County coroner, told the board in a May 24 email.

Earlier this year, Ortiz reported that the central Ohio county saw 520 overdose deaths in 2017, a 47 percent increase from the previous year.

Her comments were echoed by several groups, including Prevention Action Alliance, which works to stop substance abuse before it starts. The group believes requiring the anti-overdose drug will give both patients and doctors pause and reduce overprescribing of opioids.

Not everyone thinks the rules go too far. Some doctors worry that requiring the anti-overdose drug will confuse patients and lead to some foregoing needed medication.

Some patients in need of pain pills told the board they're worried about losing access to pills that help them go about daily life easier.

"Without these medications I believe I would be bed-ridden and still be in devastating pain," a retired Cincinnati police officer told the board in a May 23 email.

Restrictions enacted last year set limits for doctors prescribing narcotic pain pills for acute pain typically caused by an injury or illness. Those rules included barring doctors from prescribing more than seven days of narcotic pain pills for adults or more than five days for children.

Ohio previously said people with short-term pain from injuries or surgery should be given alternatives to prescription painkillers whenever possible and be provided only the minimum amounts if absolutely needed.

Ohio has also set guidelines to reduce the prescribing of painkillers in emergency rooms.

The medical board meets June 13 to consider comments on the proposals.