feetIn Parts I, II, and III of this series we established the acute and growing effects that the opiate painkiller epidemic is having in America, and how it has been driven (in part) by aggressive pain management strategies that were implemented since Pain was identified as the 5th Vital Sign.  Since then, public health and other sectors have been responding by developing and implementing strategies to break the cycle of opiate misuse and abuse.

The CDC recently recommended a number of strategies states can employ including: 1) electronic Prescription Drug Monitoring (which AZ has through the Arizona Board of Pharmacy); 2) patient review and restriction programs within state Medicaid programs to monitor prescription claims data for inappropriate use of controlled prescription drugs (AHCCCS does this); 3) implementation of health care provider accountability programs to ensure providers are following evidence-based prescription guidelines (we have Guidelines); 4) enacting state laws to prevent doctor shopping and the rogue operation of “pill mills” (some AZ laws exist); and 5) providing affordable, comprehensive, and meaningful substance abuse treatment programs (we do this through our behavioral health services division).

The Arizona Substance Abuse Partnership endorsed a Prescription Drug Reduction Initiative, known as the Arizona Prescription Drug Misuse and Abuse Initiative. Using the strategies proposed by the Office of Drug Control Policy as a starting point the partnership developed a set of data-and-research-driven strategies to be used in a multi-systemic, multi-agency collaborative approach to reduce prescription drug misuse in Arizona.  Initiative participants have also developed Arizona Guidelines for Dispensing Controlled Substances and the Arizona Guidelines for Emergency Department Controlled Substance Prescribing as well as draft new Arizona Opioid Prescribing Guidelines for all healthcare providers.

At the national level, the Joint Commission issued a new Sentinel Event Alert recommending that health care organizations take defined steps to improve their response to and reporting of prescription drug misuse and abuse including: 1) monitoring patients who are receiving opioids on an ongoing basis; 2) using pain management specialists or pharmacists to review pain management plans; 3) providing education and training for clinicians, staff and patients about the safe use of opioids; and 4) using standardized tools to screen patients for risk factors such as over-sedation and respiratory depression.

At the state health department level, the Association of State and Territorial Health Officials’ 2014 President’s Challenge is to “reduce the rate of nonmedical use and the number of unintentional overdose deaths involving controlled prescription drugs 15% by 2015”.  The President’s Challenge includes a strategic plan to implementing evidence-based Prevention Strategies, Monitoring and Surveillance, Control and Enforcement, and Treatment and Recovery to reach this important goal.

Now that we’ve discussed responses to the prescription drug abuse and misuse…the next question to ask is whether these collective intervention efforts are enough to turn the tide.  We’ll tackle that in Part V.