American Society of Regional Anesthesia and Pain Medicine February 2018 - 10

state legislature passed legislation that required continuing medical
education for all providers on these same topics.
Pennsylvania leadership recognized the need to establish a
prescription drug monitoring program (PDMP) that providers
could use to guide clinical decision-making related to prescribing
controlled substances. The Pennsylvania PDMP went live for
licensed prescribers and dispensers in 2016; those sources
are now required to register with the program. Additional state
legislation quickly led to adoption of a requirement that all
providers query the PDMP
before prescribing any opioids
and benzodiazepines. As a
result, more than 94,000
providers registered with the
Pennsylvania PDMP in the
first 12 months of operation,
and an average of 52,000
queries are completed during
a typical workday. In 2017,
the Pennsylvania PDMP became capable of providing data from 15
other states and Washington, DC.

In addition, several published reports have documented that
physicians routinely overprescribe opioids for acute pain, resulting
in large numbers of unused opioids being left in the home, often
unsecured, and thus readily available for nonmedical use. To
decrease the availability of unused opioids and other medications in
the home, Pennsylvania created the Pennsylvania Prescription Drug
Take-Back Program. Under the leadership of the Department of
Drug and Alcohol Programs, the commonwealth has collected and
destroyed 301,388 pounds of drugs since 2015.
Pennsylvania has also
made progress in
expanding naloxone
availability for the
treatment of opioid
overdose. This included the
physician general signing
a standing order to make
naloxone available to first
responders (as well as
the general public), allocating several million dollars to provide
naloxone for first responders. Since the start of the program,
increased availability has led to 3,988 reversals of opioid overdoses
by Pennsylvania law enforcement using naloxone.

"This Pennsylvania story has been one
of partnership among state government
leadership with health professionals and
patient advocacy organizations."

The system will soon integrate with electronic health records to
facilitate the availability of PDMP data in guiding clinical decisionmaking. Initial data indicate that the availability of the PDMP is
impacting provider prescribing. In fact, the number of people
receiving schedule II medications from more than 10 physicians
and pharmacies has essentially been eliminated, and the number
of people receiving schedule II medications from more than 5
providers and pharmacies has decreased by more than 80%. PDMP
data demonstrate a decrease in opioid prescribing of 12.6% since
the third quarter of 2016.
Concern is growing about the impact of physicians overprescribing
opioids for the treatment of acute pain. Between the duration of
opioid therapy and the risk of migration from acute to chronic
opioid use, the association has recognized that 80% of individuals
who use heroin report having started opioid use through use of
prescription opioids.

Pennsylvania is working on the expanded availability of
medication-assisted treatment for opioid use disorders through
a series of grants offered to providers to explore transformative
methods of providing expanded addiction treatment throughout
the state. This program, the Pennsylvania Coordinated Medication
Assisted Treatment, expands medication-assisted treatment
through a hub-and-spoke model with an addiction-medicine
physician as the hub, networking with primary care providers as
the spokes.
Although considerable more work needs to be done, the experience
in Pennsylvania and other states demonstrates that progress can
be made when state government leadership effectively partners
with health care professional leadership and others to develop and
implement sound policy to address a pressing public health need.

American Society of Regional Anesthesia and Pain Medicine
2018

Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine February 2018