New state guidelines could change how Pennsylvania physicians prescribe opioids to their patients.
Some of the most commonly prescribed opioids in the U.S. are hydrocodone, oxycodone and morphine.
The guidelines urge providers to use restraint and caution in prescribing the commonly abused drugs, said Scot Chadwick, legislative counsel at the Pennsylvania Medical Society.
"They are voluntary," he said of the guidelines, "but physicians went into medicine to heal people and make them better ... If we can provide them with tools, we believe a large majority of physicians will gratefully accept this advice."
Combined effort: In December 2013, Gov. Tom Corbett established a task force of more than 70 individuals to analyze the state's prescription opioid abuse problem, Chadwick said.
Around the same time, the medical society formed its own work group to study the issue. The two efforts eventually merged and produced the statewide guidelines for health care providers who treat chronic, non-cancer pain, he said.
"These have wide support," Chadwick said. "We're marketing them very aggressively to our members, and we're hoping that the other stakeholders will do the same."
The guidelines recommend treating chronic-pain patients with a variety of approaches, such as physical and cognitive-behavioral therapy.
Chadwick said the likely result of the guidelines is that the state will see some degree of reduced prescribing of opioids — and therefore fewer people abusing them.
Locally: WellSpan Interventional Pain Management predominately treats chronic-pain patients and has its own opioid prescription guidelines, said Dr. To-Nhu Vu, medical director of the York Township practice.
"This is something that, within our system, we have been meeting and talking about for the past five years ... Truly, we're in the middle of an epidemic," she said.
Not everyone is an ideal candidate for opioids, Vu said, and the practice's guidelines offer alternatives to helping patients with pain, such as massage, acupuncture and therapy.
Contracts: For chronic-pain patients who do want to use opioids, the practice has a system in place, she said. Most of those patients have opioid contracts — an agreement between the provider and patient that outlines certain expectations — and are monitored by the physicians through an electronic record database, she said.
The state guidelines also recommend the idea of a patient contract.
"I'm happy to see that the guidelines that we sort of integrated within our system are very similar to the guidelines that are being recommended," Vu said.
The practice uses urine toxicology screening to make sure patients adhere to their doctors' recommendations and are not taking medications that weren't prescribed, she said. If providers have any concerns, the contract allows them to ask for the screening at any time and conduct one at least once every six months to a year, Vu said.
She said she hopes other practices in the community follow the guidelines.
"I feel that these guidelines should be used by anybody prescribing opioids long-term," Vu said, adding that many primary care providers deal with chronic-pain patients on a regular basis.
New guidelines: The society and the Pennsylvania Chapter of American College of Emergency Physicians have also adopted a second set of guidelines for prescribing opioids in the hospital emergency department, Chadwick said.
Using the drugs to treat acute pain resulting from injury requires a different set of guidelines than treating chronic pain long-term, he said.
Corbett's task force will review them in a meeting later this month, Chadwick said.
The state guidelines are available online at www.pamedsoc.org/opioidguidelines.
— Reach Mollie Durkin at firstname.lastname@example.org.