clinicianIn Parts I, II, III, and IV 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 (presented in Part IV) to break the cycle of opiate misuse and abuse.  Today, we continue presenting interventions being conducted to address the epidemic.

In 2008 the Arizona Legislature passed and Governor signed a law establishing the Controlled Substances Prescription Monitoring Program.  The law required the Arizona State Board of Pharmacy to establish a controlled substances prescription monitoring program requiring pharmacies and medical practitioners who dispense controlled substances to report prescription information to the Board of Pharmacy on a weekly basis.  The Monitoring Program is one of the most important tools health care providers can use to manage patients.

The passage of a new law this year allows prescribers to appoint an office designee to access their patient’s medication history from the Monitoring Program just like they do patient charts.  This will cut down on prescriber time and still ensure patient safety and minimize liability concerns.  The system will be ready to accept designees starting in early September.  The new legislation requires updates every 24 hours (rather than weekly) and will help reduce dangerous drug combinations and high-dose prescribing.

At the national level, the U.S. Drug Enforcement Administration is revamping rules on providing prescription drug drop boxes in the community.  Currently the only place that can have a drop box is at the police department.  People may be more likely to properly dispose of unused drugs if they can do so year-round in places other than at a police or sheriff’s department.  Existing drop box locations are posted on the Arizona Prescription Drug Misuse & Abuse Initiative website.

The University of Arizona’s Office of Continuing Medical Education in conjunction with the Center for Rural Health is developing an online prescribing education tool that provides controlled substance prescribers in Arizona continuing graduate medical education credits for free upon completion of the interactive program.  The online education will align with and help promote Arizona’s Opioid Prescribing Guidelines.

Non-traditional approaches to pain management are finding their way into the conversation as alternative means individuals can embrace in order to manage their pain experience without having to depend on prescription drug therapy.  Meditation, yoga, acupuncture, changes to diet, chronic disease self-management, and a number of other choices are being adapted and adopted as viable alternatives to traditional pain management therapies.

The key to winning this battle is to align and focus our future efforts in a comprehensive manner.  The Institute of Medicine set this strategy in motion with their 2011 publication, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.  The Blueprint emphasized steps individuals, providers, and communities can take to prevent pain from occurring in the first place.  For example, public health partnering with primary care to provide community education to address behavior and lifestyle choices that lead to chronic disease, i.e., obesity, that contribute directly to the prevalence of chronic pain.

The painkiller misuse and abuse problem represents a perfect storm.  In the last several years a number of forces have coalesced to create a complex and dynamic public health problem for which no single silver bullet policy has been able to successfully take down.

Steps continue to be taken to develop, implement, and assess the effectiveness policies are having on reversing the deleterious effects of this epidemic – but the jury is still out on the question of whether the constellation of interventions that are being implemented at the federal, state and local level are enough to turn the tide on this critical public health crisis.