Ending Opioid Dependence Among Chronic Pain Patients
“The scourge of heroin and opioid abuse is an extraordinary crisis requiring an all hands on deck approach,” Maine Attorney General Janet Mills wrote to health care providers last week. Her letter noted 21 apparent overdose deaths in Maine from prescription and street drugs in November and urged prescribers to help save lives by “reining in the proliferation of opioid painkillers in our state, now tallying more than a million prescriptions each year.”
For over a year, the Maine Chronic Pain Collaborative has been taking practical steps toward achieving what the attorney general, and all responsible health care providers, seek: a drastic reduction in opioid prescriptions and, by extension, opioid dependence, addiction and overdose deaths.
In simple terms, the Collaborative is a cadre of 24 primary care practices that is working with Maine Quality Counts to learn how to free chronic pain sufferers from dependence on opioids like morphine, oxycodone and fentanyl. Eight practices have already completed the Collaborative’s training and some providers from that group have returned to the collaborative to share their best practices. One, Kristen Silvia, MD, has shared on video lessons learned from successfully “tapering” her chronic pain patients’ opioid use.
The Collaborative held its second in-person learning session on November 19th with over 60 attendees and 13 practices. Chronic pain patient and founder of the Chronic Pain Support Group of Southern Maine, Susan Dudley Gold set the tone for the day, providing eight steps to fostering a relationship between patients living with chronic pain and healthcare providers.
“Show that you are listening to what your patient is saying,” said Dudley Gold to the gathered health care providers. “Use body language (nodding your head or leaning forward) to show that you are listening.”
The day-long learning session included a keynote address by R. Corey Waller, MD, MS, an Addiction and Pain Specialist with the Center for Integrated Medicine of Spectrum Health Medical Group in Grand Rapids, Michigan who discussed their team based approach to care. Dr. Dora Anne Mills, MD, MPH, Vice President of Clinical Affairs at the University of New England (UNE), facilitated a panel from UNE consisting of Garrett Edwards, Doctor of Osteopathy; J. Adrienne McAuley, Physical Therapist; and Mary Elizabeth Patnaude, Occupational Therapist discussed the benefit of interdisciplinary approaches to treating chronic pain.
Trip Gardner, MD, Chief Psychiatric Officer with Penobscot Community Health Center, discussed the history, indications and contraindications of benzodiazepines, encouraging prescribing providers to discuss with patients the risk benefit ratio for benzodiazepines as their use may become adverse for many beyond 2 to 4 weeks of use.
The day ended with an analysis of Maine’s Prescription Monitoring Program (PMP), highlighting prescribing trends in opioid, sedative, and stimulant prescribing. Stephanie Nichols, Pharm. D., Associate Professor at Husson University School of Pharmacy, noted that in Maine in 2014, 135.4 million dosage units (e.g., tablets, capsules, patches, etc.) and 52.2 million days-supply of controlled prescription drugs were prescribed and dispensed and which is enough to medicate every man, woman and child around-the-clock for more than a month. In reporting the number of opioid prescriptions per capita by county, Nichols noted that while hydrocodone and oxycodone prescriptions consistently declined from 2010 to 2014, buprenorphine prescriptions have increased more than any other opioid in the same timeframe. She further reported that stimulants are the fastest growing category in the Maine PMP with a 91% increase in annual prescriptions from 2006 to 2014 and there may be an upward trend in the proportion of adults 60 years and older in Maine who are receiving benzodiazepine prescriptions despite cautions regarding their use in older adults. John Lipovsky , Program Coordinator of the Prescription Monitoring Program (PMP) illustrated how providers may use the PMP to improve patient care, reduce the misuse, abuse and diversion of prescription drugs and reduce prescription drug overdoses.
This round of the Collaborative will continue to meet in person and online for the next eight months. Funding for the Maine Chronic Pain Collaborative is provided by the Pfizer Independent Grants for Learning and Change Group and the Harvard Pilgrim Health Care 2015 Quality Grants Program.