NYSAM’s Position on Prescription Drug Abuse

Much is being proposed to help reduce the prescription drug abuse problems in New York State. NYSAFP
and MSSNY have both made suggestions. The American Society of Addiction Medicine is preparing a position paper that will address provider education and prescription monitoring programs. The New York Society of Addiction medicine is bring forth two other suggestions which we hope will be considered as solutions are sought for this problem in our state.

1. NYSAM encourages the development of quality indicators related to the prescribing of controlled substances. For example, some doctors never do urine drug screens, Insurance companies and Medicaid know this but never suggest it. The same can be said of other important quality indicators. Physician organizations, insurance companies and other payers should develop these indicators, provide education around them and use them t help improve patient care.

2. Physicians should receive adequate reimbursement for the evaluation and management of patients on controlled substances. It takes just a minute to write a prescription and the patient usually leaves happy. It takes more time to evaluate whether a patient is a good candidate for a potentially addicting medication. For the optimal management of chronic pain patients, old records need to be reviewed, and there is a need for patient education and careful follow-up. These services are not adequately reimbursed. Insurance companies pay for expensive injections and for opioid prescriptions but they often do not pay for counseling or comprehensive multi-disciplinary team approach, even though studies show that this is often the most effective approach to chronic pain problems.

Prescription Drug Abuse

NYSAM is concerned about prescription drug abuse. We plan to have a Public Policy Forum in New York City on Friday, February 3, 2012 from 2:00 pm to 5:00 pm, the day before our 8th Annual Scientific Conference at The New Yorker Hotel, 481 Eighth Avenue, New York, New York.

At the forum, we will have several of our members speak and then have several members of governmental agencies, the assembly and state senate speak. Much of the three hours will be spent in discussion and dialogue.

Under Public Poliyc Resources on our website, we have previous testimony given to a Assembly Committee last year. Below is what the NYSAM Public Policy Committee has developed so far this year. We want input from all our members.
Do you agree with what we have written so far? What additional ideas might you offer. Please reply through the website www.nysam-asam.org or e mail Norm Wetterau at  normwetterau@aol.com.
You do not have to be a member of our Public Policy Committee to have this input. Please mark your calendars for these two important events.

In order to provide optimal care for a patient, a physician must be aware of the medications that patient is already taking.  It is well known that some patients are receiving controlled substances in excess of recommended dosages, receiving prescriptions from multiple providers, and misusing the medications. These patients often do not volunteer this information to the physician. NYSAM believes that knowing if a person is receiving prescriptions for controlled substances from other providers before prescribing any potentially addictive medication, proper prescribing, and careful follow-up are part of providing good medical care. We are therefore offering these suggestions that might help patients all over New York State receive the best possible treatment:

1.        Physicians should have online access to information on all
controlled substances prescribed for his or her patient. Right now such access is very limited.  If only one change can be made in the current rules, it should be this:  Such access should be easy to obtain but only available to the patient's physician, PA or NP.

2.       Physicians should receive adequate reimbursement for the evaluation and management of patients on controlled substances. It takes just a minute to write a prescription and the patient usually leaves happy. It takes more time to evaluate whether a patient is a good candidate for a potentially addicting medication.  For the optimal management of chronic pain patients, old records need to be reviewed, and there is a need for patient education and careful follow-up. These services are not adequately reimbursed. Insurance companies pay for expensive injections and for opioid prescriptions but they often do not pay for counseling or comprehensive multidisciplinary team approach, even though studies show that this is often the most effective approach to chronic pain problems.

3.       NYSAM encourages quality indicators related to the prescribing of controlled substances. Some doctors never do urine drug screens and insurance companies and Medicaid know this, but never suggest it. The same can be said of other important quality indicators.  Insurance companies and other payers should develop these indicators and use them to help improve patient care.

4.      Education should be available for all who presecribe controlled substances, but only required for those who are having problems. Doctors can attend a course but not change the way they do things. If Medicaid and insurance companies had quality indicators, that would help determine which doctors are doing a good job prescribing. Providers who are doing a good job should not be required to take such a course. Many of them have already taken similar courses, or have read extensively on the subject.

Mouth-to-mouth resuscitation is essential in responding to opioid overdoses

ALERT:
Mouth-to-mouth resuscitation is essential in responding to opioid overdoses.

Overview of Opioid Overdose Prevention Programs in New York State

Overview of Opioid Overdose Prevention Programs in New York State

Drug overdose is a significant problem in New York State. Recent data from New York City indicate that nearly 1,000 fatalities resulted from accidental overdoses in 2006. Close to 70% of these deaths involved the use of opioids/heroin.  Many of these deaths and the morbidity from non-fatal overdoses can be prevented.

A new life-saving law took effect in 2006, making it legal in New York State for non-medical persons to administer Naloxone to another individual to prevent an opioid/heroin overdose from becoming fatal.  The New York State Department of Health (NYSDOH) registers eligible agencies and providers to operate an Opioid Overdose Prevention Program and provides the required supplies for free.  These programs train individuals how to respond to suspected overdoses including the administration of Naloxone.

Naloxone (Narcan) is a prescription medicine that reverses an overdose by blocking heroin or other opioids in the brain for 30 to 90 minutes. Naloxone is administered by injection (and in some places intranasally). It is successfully prescribed and distributed to heroin users, their families and friends in numerous locations in the U.S., including Baltimore, Chicago, New Mexico, Massachusetts, Michigan, San Francisco and New York. Hundreds of individuals participating in these programs have safely and successfully reversed overdoses.  In New York City, over 4,500 individuals have been trained as opioid overdose responders and have reported over 390 overdose reversals.

Registering as an opioid overdose prevention program is easy and not time-consuming.  The application form is simple and prototype policies and procedures, and a training curriculum, are available that can be tailored for any agency depending on the particular setting. 

Program Requirements for a NYSDOH registered opioid overdose prevention program are straight forward and not demanding.   Each program must have an opioid overdose program director and an opioid overdose clinical director who are responsible for complying with the program requirements and insuring the quality of the training performed by the agency.  The clinical director can be an MD, PA, or NP.  Agencies that do not have medical providers on staff may hire someone for this function for a limited number of hours.  Naloxone can only be given out by a medical professional, but the training on overdose prevention and response can be done by any competent staff member.  Other program requirements involve record keeping about trainings done, people trained, use of naloxone by trainees, and supply inventory.

Implementation varies among agencies according to their needs and settings.  Some agencies only train employees, while others train employees and clients.  Others implement screening for overdose risk and training in prevention even if no naloxone is distributed.

The Harm Reduction Coalition is available to provide assistance in implementing opioid overdose prevention programs. We can help by training staff, discussing the application for NYSDOH registration, and helping to determine training needs of staff and clients.   212-213-6376  Stancliff@harmreduction.org ext 39 or Matthews@harmreduction.org ext 38

For more information from New York State Department of Health:   http://www.health.state.ny.us/diseases/aids/harm_reduction/opioidprevention/index.htm

For more information from the New York City Department of Health and Mental Hygiene:

http://www.nyc.gov/html/doh/html/basas/od-provider.shtml

A Continuing Medical Education credit may be earned here:

http://www.ceitraining.org/cme/

A CASAC credit may be earned here:

http://www.oasas.state.ny.us/admed/edseries.cfmdseries.cfm

Harm Reduction Coalition . 22 West 27^th Street 5^th Floor . New York ,  NY 10001

212-213-6376

www.harmreduction.org



Update on Medical Marijuana and New York State

Medical Marijuana did not pass last year. We thank all the members of NYSAM who wrote to, called or meet with New York State Legislators to advocate our position of opposition to smoked medical marijuana. The Senate race for New York is still undecided but if Republicans take control of the state senate, passage is unlikely. Governor elect Cuomo has also stated his opposition. There has been much in the national news on this subject. MSSNY has modified their position and NYSAM has upcoming CME on Marijuana.

Click to read more ...