A Round Table Discussion: Dental Support Organizations’ (DSO) Views on the Opioid Epidemic, Part II

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To continue our round table blog series, we shed light from the technical side of dentistry’s role in the opioid epidemic. This time, we sat down with Jason Wolan, Director of EHR Implementation at Great Expressions Dental Centers.

How does your organization view the opioid epidemic as well as your dentists’ role in this crisis?

Great Expressions Dental Centers recognizes an opioid epidemic in this country driven largely by what has historically been a very lax approach to responsible prescribing. Today a lack of commitment by major stakeholders to take hard stances on better regulating the manufacturing and supply of these drugs continues to fuel the fire. In many cases, exploration of alternative pain management therapies and more rigid prescribing protocols that mitigate excess supply and drive more frequent doctor-patient interaction for those on long-term pain management therapies would likely result in major strides to not only reduce excess supply, but reduce unnecessary consumption as well. As a leading DSO and supplier of these medications, it is our job in the dental industry to lead by example and set progressive prescribing protocols that focus on responsible pain management therapies reinforced by firm controls and processes that deter abuse.

Are you having internal conversations about how your organization can curb the use of opioids or dispense trends?

Internally, our transition to an electronic prescribing platform has really been the catalyst for all of this primarily allowing us to gain insight into the prescribing habits of our providers. Prior to prescribing electronically, we relied heavily on spotty computerized provider order entry (CPOE) and “good faith” prescribing based on paper prescriptions being written with little or no audit trail. Today, we are phasing out paper prescribing with an ultimate goal of reporting on prescribing habits, particularly as they relate to opioid prescribing, allowing us better insight into drug-volume and drug-frequency combinations that may raise red flags.

How do you think e-Prescribing assists in efforts to curb opioid prescribing habits?

First and foremost, e-Prescribing, as is the case with most transitions to electronic mediums, will allow for better organizational oversight which will likely cause an industry shift as providers begin to recognize the results of increased transparency. Access to this aggregated data will create an unprecedented level of ad-hoc and scheduled reporting of prescribing habits with the ability to begin to profile behaviors and automatically intervene as necessary. In the past, while prescribing could be tracked, much of the data was burdensome and time consuming to compile, but as electronic prescribing platforms and the industry standards have become so available, the ease with which most organizations can monitor and proactively engage providers today should be a major driving force in deterring abusive prescribing. Reinforcing the latter will come with a societal transformation of less tolerance for prescriber supported prescription drug abuse and the increased media coverage, both at the state and federal level, prosecuting the offending prescribers.

Do you have access to data that you currently, or plan to, utilize in regards to proving how your practices are focused on responsibly prescribing these substances?

Great Expressions Dental Centers is currently generating weekly reports of prescribing focused on drug-volume/drug-frequency combinations. While the organization has not completely transitioned to electronic prescribing, we have significantly reduced access to paper prescribing and expect to see the true value of electronic prescribing when we are able to profile our organizational prescribing practices in its entirety.

Are there any policies in place, or may be in the future, regarding how many pills should be dispensed per controlled substance?

As a DSO, our clinical operations, policies, and procedures, and guidelines are all set by our Chief Clinical Officer. A consistent patient experience defined by responsible care coordination for all Great Expressions Dental Center’s patients is the cornerstone of the brand we have established. A large part of that includes driving responsible practicing techniques and ensuring that our patients’ interests are front and foremost, this of course includes responsible prescribing to mitigate the risks associated with opioid prescribing and has existed prior to our engagement with electronic prescribing. In the future, we hope to leverage the platform further in this regard.

To listen to the full round table, download your copy here.

Some responses have been slightly edited for clarity and length.

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

A Round Table Discussion: Dental Support Organizations’ (DSO) Views on the Opioid Epidemic, Part I

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As the opioid epidemic continues to grow across the nation, DoseSpot recently sat down with Key Opinion Leaders from Dental Support Organizations (DSOs) to discuss how their organization is implementing best practices to decrease opioid overdose deaths and increase patient safety, as well as their viewpoint on what dentistry’s role is during this crisis.

For part I of our blog series, our focus is on the clinical element of dentistry’s role in the opioid epidemic with Dr. John Zweig, Chief Dental Officer of Dental Associates.

How does your organization view the opioid epidemic as well as your dentists’ role in this crisis?

Dental Associates is keenly aware of the problem with opioids and we take a very deliberate role in managing patients’ pain appropriately with the minimum required medication. Educating patients and matching pain relief management with the present dental problem is very important.

Do you provide your dentists education, training, or resources regarding controlled substances?

Continually, Dental Associates has educated its providers on appropriate pain control measures and the use of controlled drugs. The challenge remains with patients whom insist on strong medications and working with them to minimize the prescriptions and the type of drugs used. More patient education is required, and our use of patient prescription histories is becoming more widely used to discover how to explain the minimum amount of medication used.

Within your dental practices, how do you communicate the important relationship between dentists and controlled substances?

Within our provider education, orientation and our monitoring of prescriptions, we continue to provide feedback to minimize prescriptions for controlled drugs both in type and quantity of medication provided.

How do you think e-Prescribing assists in efforts to curb opioid prescribing habits?

It actually reduces fraud; it ensures that we are writing the prescriptions the way we want them to be and that they get to the right people. Electronic prescriptions allows us to monitor this because potentially we may have a provider who is unknowingly or unwittingly giving out large amounts of drugs and we can have a conversation with them, potentially educate them, or make them aware of the situation. This isn’t about a “gotcha game,” it’s about educating providers on best practices.

How do you handle/communicate with patients that may have a substance abuse issue?

Well, many times, first, we use the Wisconsin prescription drug monitoring program (PDMP). That has been in existence and the state has been encouraging us to use it. When using it, we find that many of the patients we’re concerned about are in pain management programs and so we refer them back to their pain managers to resolve their pain needs, so we’re not making it too complicated. For those not in a pain management program, we communicate the facts on their known prescriptions and advise them that we may be unable to prescribe more. We discover with that information, the push-back is minimal.

Anything else you think would be relevant in addressing dentistry’s role in curbing this epidemic?

The issue is a big problem, but I still think it requires education for patients and also the providers, because people have the expectation to reduce demand for pain medication. We need to educate the doctors on best practices with medications that are not controlled substances. We need to monitor and educate everyone.

Stay tuned for Part II: DSOs’ technical insight into dentistry’s role in the opioid epidemic.

To listen to the full round table, download your copy here.

Some responses have been slightly edited for clarity and length.

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

Opioid Road Map: How the Government Plans to Battle the Opioid Epidemic by Utilizing PDMPs

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The opioid crisis has taken our nation by storm, claiming an average of 78 victims a day, all of whom lost a vicious battle with opioid addiction. According to the National Governors Association, the current epidemic is being fueled by inappropriate opioid prescribing, as 4 out of 5 heroin users reported misusing prescription opioids before switching to heroin. Now, governors across the United States are taking action against the epidemic with a range of public health and safety strategies that address everything from prevention to treatment to recovery. In order to successfully attack the opioid crisis head on, they’ve decided to create an Opioid Road Map which will act as a tool to outline these strategies for states nationwide.

A Road Map Was Born

The Road Map was developed by the National Governors Association (NGA) to help states respond to the growing crisis of opioid abuse and overdose, as well as strengthen law enforcement efforts and abilities to address illegal activity. The individual state can either follow the road map step-by-step or they can pick and choose which pieces to utilize based on their needs.

The Opioid Road Map is a three-part process as outlined by the NGA:

Step 1 – Assess the Situation

Step 2 – Develop and Select Policies

Step 3 – Finalize Policies, Implement, and Evaluate Results

To develop the Road Map, the NGA worked with 13 states between 2012 and 2015 to create effective statewide programs to battle the opioid epidemic. Input was received from multiple stakeholders including pain specialists, law enforcement officials, health care payers, substance use disorder treatment professionals, and more. Numerous resources were shared in order to build this Road Map and having the ability to optimize and utilize the data collected from state Prescription Drug Monitoring Programs (PDMPs) was key to the Road Map’s creation.

The Role of PDMPs

The PDMPs of individual states is a database that contains controlled substance prescribing and dispensing data submitted by pharmacies and prescribers. This information is used to monitor and analyze all prescribing activity for use in abuse prevention, research and law enforcement. In regards to the Opioid Road Map specifically, the NGA is encouraging states to use their PDMPs as a tool for prescribers to gather real-time information on prescription opioids, and to analyze trends and outcomes associated with policies and programs.

According to the NGA, in order to maximize the use and effectiveness of state PDMPs, the following should be required:

• Prescribers should be querying PDMPs before prescribing Schedule II, III, IV controlled substances
• Pharmacists must report to the state’s PDMP within 24 hours of dispensing
• PDMP data must be used to provide proactive analyses and reporting to professional licensing boards and law enforcement
• PDMPs must be easy to use and PDMP data should be integrated into the Electronic Health Record (EHR)
• PDMPs should be interoperable with other states

Since these Prescription Drug Monitoring Programs already exist within forty nine states, it would be beneficial to utilize this data not only for preventing occurrences such as “doctor shopping” (people seeking multiple pain prescriptions from multiple prescribers) and identifying at risk patients, but also for achieving goals put forth by the Road Map in relation to research, law enforcement, and policy reform.

Road Map Expectations

By utilizing the Road Map, states will find background information on the current issue of opioid abuse and which factors are involved with prescription opioid misuse and addiction. They will also have access to the different steps outlined which act as a how-to guide for assessing the situation, selecting policies, and evaluating initiatives. Another item of value they could get from using the road map is a summary of evidence-based health care and public safety strategies to reduce opioid abuse.

By utilizing the Road Map, states will be able to work together to not only brainstorm about how to prevent and respond to the opioid epidemic, but more importantly, they will be able to put a plan into action which will achieve those defined objectives, with the ultimate goal of saving more lives in the process.

Author: Shannon K.

Sources: National Governors Association; NGA Road Map Outline; GCN Magazine

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

e-Prescribing 101, Part II: Controlled Substances

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To continue our e-Prescribing 101 blog series, we shine light on controlled substances. What they are, their relationship to e-Prescribing, as well as the correlation between prescription drugs and the current opioid epidemic.

What is a controlled substance?

A controlled substance is a drug or chemical, such as illicitly used drugs or prescription medications, that is regulated by a government based on the drug or chemical’s manufacture, possession, or use.

Why are certain drugs categorized as a controlled substance?

A drug is typically classified as “controlled” due to the potential detrimental effects on a person’s health and well-being. As a result, state and federal governments have seen fit to regulate such substances.

It’s for this reason that drugs, substances, and certain chemicals used to make drugs of this caliber are classified into five categories. The drug segregation is dependent upon the drug’s acceptable medical use and the drug’s abuse or dependency potential.

What are the medication schedules for controlled substances?

Schedule I

• Drugs with no currently accepted medical use and hold a high potential for abuse.
• Examples: Heroin, Marijuana (Cannabis), LSD, and Ecstasy

Schedule II

• Includes drugs that are accepted for medical use, but have a high potential for abuse, with use potentially leading to severe psychological or physical dependence.
• Examples: Vicodin, OxyContin, Adderall, and Ritalin

Schedule III

• Drugs with a moderate to low potential for physical and psychological dependence, with less abuse potential than Schedule I or Schedule II drugs.
• Examples: anabolic steroids, testosterone, and Tylenol with codeine

Schedule IV

• Drugs within this category have a low potential for abuse and dependence.
• Examples: benzodiazepines (Xanax, Valium, Ativan), Tramadol, and Ambien

Schedule V

• The lowest schedule for controlled substances, these drugs have lower potential for abuse and consist of preparations containing limited quantities of certain narcotics.
• Examples: Robitussin AC, Lyrica, and Motofen

What is EPCS?

EPCS stands for the Electronic Prescribing of Controlled Substances and is a technology that has been put into place to help address the rising issue of prescription drug abuse in the United States.

Understanding two-factor authentication

This two-step process is part of EPCS and ensures that only an authorized prescriber can electronically sign and send controlled substance prescriptions to a pharmacy, thus increasing patient safety. The process includes the entry of something you have, such as a token generated one-time code, and something you know, like a password. There are various options for two-factor authentication including: fob tokens, mobile phone applications, smart cards, USB thumb drives, and fingerprint scanners.

What is an opioid?

Opioids are substances that act on the body’s opioid receptors to produce euphoric effects, better known as a “high”, and are most often used medically to treat moderate to severe pain that may not respond well to other pain medications.

Why are opioids so addictive?

Opioid drugs work by binding opioid receptors in the brain, spinal cord, and other areas of the body to reduce the sending of pain messages to the brain, thus simultaneously reducing the physical feelings of said pain. They create artificial endorphins, the body’s natural painkillers, which tap into the “reward” sector of someone’s brain. However, with chronic use, opioids eventually trick the brain into stopping the production of these endorphins naturally. In doing so, the tolerance level increases and a patient is left with taking more medication to achieve the same effect.

They are most dangerous when taken in certain ways to increase the “high”, such as crushing pills and then snorting or injecting the powder, or combining the pills with alcohol or drugs, especially benzodiazepines. While some patients do take them for their intended purpose, they can still risk dangerous adverse reactions by not taking them exactly as prescribed, i.e. they take more at one time, or combine them with other medications not checked by their doctor.

Unfortunately, the fear of the intense withdrawal symptoms is often the biggest culprit when it comes to patients remaining addicted and ultimately leads them to continue taking the medication even if they no longer want to.

The correlation between prescription opioids and the opioid epidemic

In 2012 alone, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills. In comparison to ten, even five years ago, this number is dramatically increasing as time goes on and more and more opioid overdoses are being reported on a daily basis.

Physicians and dentists are collectively responsible for providing 81.6% of opioid prescriptions in the United States and because of this, they have a very unique role in mitigating the impact of this opioid epidemic. Opioid addiction often starts at the hands of healthcare professionals simply trying to do their job, prescribing pain medications to relieve their patients of painful woes, especially during post-operative recovery.

While many prescriptions are meant for initial, short-term treatment, some doctors and dentists authorize refills time and time again because they want to help patients whom claim that they are still in pain. However, when the pill bottle and refills run out, patients are left seeking alternatives to create that euphoric escape they’ve become so accustomed to. This could mean an endless search of several different doctors to prescribe more substances (also known as doctor shopping), purchasing pills on the black market, or worse, turning to heroin as a cheaper and more readily available alternative.

Furthermore, the associated stigma often deters patients from receiving proper rehabilitation treatment and even if they do seek treatment, the government currently limits the number of patients a single provider may treat with drugs such as buprenorphine or methadone, which are both proven to reduce cravings and save lives. This leads to many patients relapsing.

How does e-Prescribing help?

• e-Prescribing diminishes the possibilities of duplicate or lost prescriptions since the prescription is sent directly to the patient’s pharmacy.
• A patient will no longer have a paper prescription where the dispense quantity can be altered.
• Prescriber’s will have access to a patient’s medication history, therefore they can determine if a patient is doctor shopping or has a history of substance abuse.

Don’t miss the other parts of our e-Prescribing 101 series:

e-Prescribing 101, Part I: The Basics

e-Prescribing 101, Part III: End Users

Sources: DEA; DrugAbuse.gov; FDA

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

Maine’s New Mandate and What It Means for Opioid Prescribers

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Maine is well known for its rocky coastline, iconic lighthouses, sandy beaches, and lobster shacks. However, past the classic scenery is where you’ll find the state dealing with a crisis that others across the United States are also experiencing: the opioid epidemic.

In 2015, Maine suffered an astounding 272 drug overdose deaths, following 208 deaths of the same cause in 2014. Sadly, there is no end in sight. Maine’s Attorney General Janet Mills declared that drug overdose deaths are up 50% in 2016, with the first 6 months of the year experiencing 189 drug overdose deaths alone. What’s worse, the number of overdose-related deaths in 2016 is expected to reach a new record, surpassing those numbers of 2014 and 2015.

“Heroin addiction is devastating our communities,” Maine Governor Paul LePage said in a statement. “For many, it all started with the overprescribing of opioid pain medication.”

As a state with the largest number of patients per capita on prescription for long-acting opioids, the news that prescribed pain medication is further fueling opioid addiction is unsettling.

This is why Maine has decided to take action.

Maine’s new statue, “An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program,” entails a number of rules and regulations designed to reduce the harm of over-prescribing opioids relative to the abuse and misuse of such substances. This bill, signed into law by Governor LePage, mandates a number of changes for doctors and dentists who prescribe controlled substances in Maine.

[Read: The Maine Mandate – Confronting Controlled Substances Head-On]

What changes will be implemented?

Dosing and Duration of Schedule II Medications

First, this law imposes limitations on the medication dosage, as well as the duration of a prescription, that can be prescribed to a patient. According to Gordon Smith, JD, Executive Vice President of Maine Medical Association (MMA), the original bill limited opioid prescriptions to three days for acute pain and fifteen days for chronic pain. However, this legislation will now mandate a limit of seven days for acute pain and thirty days for chronic pain on opioid prescriptions. This law goes in to effect January 1, 2017.

In terms of dosing, prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 100 Morphine Milligram Equivalents (MMEs) per day to new opioid patients (after July 29, 2016). Existing opioid patients with active prescriptions in excess of 100 MMEs per day are referred to as “Legacy Patients” and prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 300 MMEs per day from July 29, 2016 to July 1, 2017.

Prescription Monitoring Program

Maine prescribers are required to query the Prescription Monitoring Program (PMP) database prior to prescribing opiates. Although this requirement has been in place since 2005, surveys indicate that only 7-20% of Maine prescribers currently utilize the state’s PMP.

The purpose of checking this central state database is to identify patients who may be doctor shopping and minimize multiple controlled substance prescriptions for one patient. This aligns with the state’s hope of empowering healthcare providers to recognize potential substance abuse and treat patients accordingly.

PMP’s can also be most effective when linked with an e-Prescribing solution. Working together, e-Prescribing eliminates the need for paper prescriptions, thus reducing the risk of altered dispense quantities, stolen prescriptions or prescription pads, and the reselling of such prescriptions before they’re filled as a means of lessening the red flags if a patient is doctor shopping.

[Read: The Link Between PDMP’s and e-Prescribing]

Continuing Education

Via this statute, prescribers must complete three hours of continuing education every two years as a condition of prescribing opioid medications. This specific addiction training is only required if a prescriber wishes to continue prescribing opioids.

Electronic Prescribing

All opioid prescriptions must be sent electronically as of July 1, 2017.

What exceptions are part of this mandate?

The Maine Medical Association (MMA) confirms that exceptions from the law’s provisions may be granted for the following:

• Cancer Patients
• Hospice Care
• End-of-Life Care
• Palliative Care
• Patients on Medication-Assisted Therapy (MAT)
• Patients receiving medication in hospitals and nursing homes

The MMA is currently seeking an exception for burn victims as well.

Due to the supremacy clause of the U.S. Constitution, federal law takes priority over state law, therefore prescribers within the Department of Veterans Affairs (the VA) cannot be regulated by this type of legislation so long as the medication is dispensed at a VA pharmacy. Furthermore, dosage and duration limits would not apply to a prescription written for a veteran by a prescriber outside of the VA system if the prescription were filled in a VA pharmacy.

How does this bill measure up?

With this bill, Maine becomes the third state behind Minnesota and New York to require e-Prescribing and the second to require the electronic sending of a controlled substance after New York imposed a similar mandate in March of 2016. Since the implementation of New York’s mandate, total numbers of opioid analgesics prescribed fell by 78% within the first four months.

Important dates to remember:

Lastly, as part of the state’s strategy, Maine has launched Dose of Reality, a website to help educate and inform their citizens of the dangers of painkillers and where to turn for help.

Author: Lindsey W.

Sources: Maine Medical Association; Maine.gov; Medscape; WCSH6; Bangor Daily News

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

Addressing Dentistry’s Role in the Opioid Epidemic

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Unfortunately, the opioid epidemic that is currently grappling the United States isn’t exactly news. Headlines appear on a daily basis in regards to this addiction, the overdoses and fatalities, as well as the healthcare community’s contribution to this crisis, both the good and the bad.

We’ve seen Congress, the Surgeon General, and many other organizations make extreme efforts to combat this crisis, yet despite the widespread media attention, many healthcare professionals still don’t realize how dangerous the drugs can be or how addictive they are.

DoseSpot recently conducted a live webinar in an effort to educate and discuss the critical role that dentists in particular play in mitigating the current opioid epidemic that is upon us and during that time, the following crucial points were made:

The blame game needs to stop

Blaming others only diverts the necessary action of collectively coming together as a nation, regardless of one’s associated industry. Healthcare, Law Enforcement, Politics – there needs to be a strong, unified foundation for which we can assemble and fight this battle together.

Break the habit: prescribing patterns of pain medication

Dentists serve a unique role in overcoming this epidemic due to the nature of their work and the procedures they perform, specifically wisdom teeth extraction. It’s a fair statement that the majority do not enter the healthcare industry with ill intent of harming their patients, yet it’s also fair to say that lack of proper education and prior pharmaceutical marketing tactics have fueled poor prescribing patterns. In order to change one’s behavior, programmed thoughts and approaches must be reevaluated.

Opioid addiction does not discriminate

This addiction can affect anyone regardless of one’s socioeconomic status or in some cases, a person’s relationship to their dentist. What DoseSpot coins as “The Insider Threat,” we reveal how certain folks pose a potential risk relative to obtaining controlled substances, both knowingly and secretively. Stories of addiction that are shared during our recent webinar further prove that opioids do not discriminate.

Solutions are available

The truth of the matter is, there is not one single solution that can work independently. It needs to be a collective effort and innovation is critical to success. There needs to be multifaceted solutions to tackle this complex problem ranging from increasing specialty training and education to proper treatment technology, data, and analytics.

To learn more on dentistry’s role in the opioid epidemic, watch the full webinar here.

Presenters:

Greg Waldstreicher, CEO, DoseSpot

Dr. John Zweig, Chief Dental Officer, Dental Associates

Donald Whamond, Chief Technology Officer, Dental Associates

Jason Wolan, Director of EHR Implementation, Great Expressions Dental Centers

Daniel Smelter, Director of Business Analysis, Benevis, Inc.

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

3 States Laying Down the Law on Opioids

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On par with our last post, the widespread media attention and devastating losses associated with our nation’s current opioid epidemic has sparked certain state legislatures to regulate and improve providers’ prescribing habits for prescription painkillers.

With good intentions in tow, some rulings seem to lack readily available solutions that are proven to curb this crisis. However, they do realize that their recent proposals do not mark the end of this uphill battle, rather multifaceted solutions need to be in place to truly, and successfully, overcome this epidemic.

[Read: Overdose Awareness – The Time to Stand Together is Now]

Here are three states that have recently proposed rulings on how opioids should be prescribed:

Vermont

Coined as a “cutting-edge” approach to overcoming the opioid crisis, Governor Peter Schumlin announced proposed limits on the number of opioid medications that could be prescribed.

Like every other state, Vermont has seen an incredible increase in deaths related to opioid and heroin overdose in recent years and Governor Schumlin is no longer sitting on the sidelines.

Earlier this year, he approached both the FDA and pharmaceutical industry in his State of the State address claiming that OxyContin “lit the match that ignited America’s opiate and heroin addiction crisis,” and that the booming American opiate industry knows no shame, an outcry after the FDA approved OxyContin for children a few months ago.

The proposed ruling states that the severity and duration of pain will determine the specific limit for a prescription of opioids. For example, a minor procedure with moderate pain would be limited to 9-12 opioid pills and the amount would increase based on the procedure performed and the level of pain a patient claims. The ruling would also require providers to discuss risks, provide an education sheet to the patient and receive an informed consent for all first-time opioid prescriptions.

The Green Mountain State’s Governor believes that limiting the number of opioid pills prescribed would be an effective way to reduce addiction, yet some folks believe the ruling would only encourage patients to seek illicit drugs elsewhere if they cannot receive pain medication through their provider.

This does make sense considering many former and current heroin abusers have stated that their addiction started from a prescription and when the pill bottle ran out, they were left seeking these drugs on the streets, which have proven to be very, if not more, dangerous than the prescription.

However, the intent of the Governor’s ruling is to prevent addiction from ever happening in the first place. His ruling is specific to cases of acute pain, therefore changing the over-prescribing habits and learned behavior of utilizing opioids as first-line therapy; habits that ensued in large part due to incentives, the surge of pharmaceutical marketing tactics and claims that painkillers were not addictive.

[Read: How Costly Are Prescription Pain Meds?]

New Jersey

With the rate of drug overdose deaths on the rise by 137% since 2000, New Jersey is another state to recently propose new regulations on how and to whom opioids are prescribed.

New Jersey, much like many other states, believes that prevention is key when fighting this crisis and they couldn’t be more correct. Unfortunately, several barriers often occur when seeking appropriate treatment after a patient becomes addicted, (for example, providers are limited to certain amounts for which they can administer reversal drugs), and therefore why not PREVENT addiction, rather than simply TREAT addiction when at many times, it’s too late?

Senator Raymond Lesniak has introduced a bill that would put restrictions on health insurance coverage for opioid medications, while also requiring prescribers to first consider alternative pain-management treatments, follow federal prescribing guidelines and explain the risk of addiction with such substances to their patients before prescribing. Furthermore, providers will need to complete several steps before receiving approval of an opioid prescription. These steps include providing a patient’s medical history, conducting a physical exam and developing an appropriate medical plan for treating a patient’s pain.

While new rulings in place can certainly shift this epidemic, Angela Valente, the executive director of the Partnership for a Drug-Free New Jersey, said it best:

“Awareness and education is the key factor in preventing the abuse of opiates—everyone must have a role in reversing this epidemic, including lawmakers, parents, coaches, educators, and yes, even doctors and dentists.” – Angela Valente

Dr. Andrew Kolodny, executive director of Physicians Responsible for Opioid Prescribing, further backs Valente’s point while also motioning that the medical community has been prescribing too aggressively.

[Read: The Opioid Epidemic: Are Dentists the Black Sheep?]

Pennsylvania

Unfortunately, Pennsylvania experienced 3,500 deaths last year as a result from drug overdose, one of the highest overdose rates in the nation.

The state has had a Prescription Drug Monitoring Program for quite a few years now, however it wasn’t functional until August 2016, when their new program was officially rolled out. Pennsylvania requires providers to query the state’s prescription drug database the first time they prescribe a controlled substance to a patient or if they have reason to believe that the patient is doctor shopping.

Governor Tom Wolf addressed other initiatives underway including requiring providers to query the database EACH time they prescribe opioids, updating medical school curriculum and continuing education, changes to the process of pain care to lower inappropriate use of opioids, and improved screening, referral and treatment for addiction.

What’s bothersome in Pennsylvania, is the method in which these substances have to be prescribed. The Pennsylvania Controlled Substance Act requires narcotic prescriptions to be handwritten on paper prescription pads, yet every other substance can be electronically prescribed. This allows the risk of written prescriptions being lost, stolen, or sold. Luckily, Senator Richard Alloway intends to introduce this measure before the legislative session’s end.

It’s promising to see how the above states are utilizing their state’s Prescription Drug Monitoring Program, or PDMP. All three require their prescribers to query the affiliated state database, however the parameters in which, or how often, they check varies.

While said efforts are better than no effort at all and states are starting to fully understand the need for multifaceted solutions in order to overcome this epidemic, one key solution is missing. E-Prescribing.

[Read: The Link Between PDMP’s and e-Prescribing]

How does e-Prescribing help combat this epidemic?

• e-Prescribing diminishes the possibilities of duplicate or lost prescriptions since the prescription is sent directly to the patient’s pharmacy
• A patient will no longer have a paper prescription where the dispense quantity can be altered
• Prescribers will have access to a patient’s medication history, therefore they can determine if a patient is “doctor shopping” or has a history of substance abuse

To learn how to incorporate e-Prescribing as a solution to the opioid epidemic, schedule a meeting with DoseSpot today.

Sources: NY Times; Boston.com; ABC News; Press of Atlantic City; PennLive

About DoseSpot

DoseSpot is a Surescriptsâ„¢ certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

Massachusetts’ Prescription Monitoring Program Takes a New Turn

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For the first 6 months of 2016 in Massachusetts, there have been almost 500 confirmed cases of unintentional opioid overdose deaths and an estimated 500 additional cases have not yet been confirmed.

The majority of overdoses found in MA are due to substances such as fentanyl and heroin, but rates of cocaine and benzodiazepines present in opioid deaths have been steady since 2014. Although the rates of heroin and prescription drugs present in opioid deaths have been decreasing due to many efforts that have been implemented across the nation, the rate of fentanyl has been on the rise. This is in large part due to the fact that many opioid addictions start at the hands of a prescriber with a prescription and when the pill bottle runs dry, patients are left seeking other options that produce the same euphoric effect.

With the rapid increase of deaths and devastation by way of the current opioid epidemic plaguing the state, Massachusetts has recently implemented further requirements concerning practitioner’s prescribing protocols. Specifically, with the state’s Prescription Monitoring Program, or PMP.

The PMP serves as a database for all prescription drugs that are dispensed across the state, including those that are highly sought after for non-medical use and represent the highest potential for abuse, better known as Schedule II-V drugs such as narcotics, sedatives, and stimulants.

When properly used, the PMP aids in the identification and prevention of drug misuse, diversion, and potential doctor shopping by providing a patient’s medication history of the past 12 months. It is meant to be utilized as a key clinical decision-making tool that allows providers to receive a big picture view of the patient they are treating in real time.

As a solution to this widespread epidemic, Massachusetts has introduced new legislation and requirements when utilizing the MassPAT (Massachusetts Prescription Awareness Tool).

Effective October 15, 2016, practitioners must abide by the following:

1. A registered individual practitioner must utilize the prescription monitoring program each time the practitioner issues a prescription to a patient EACH time for a narcotic drug in Schedule II or III.
2. A registered individual practitioner must utilize the prescription monitoring program prior to prescribing to a patient for the first time:
   1. A benzodiazepine; OR
   2. Any controlled substance in Scheduled IV or V which the department has designated in guidance as a drug that is commonly abused and may lead to dependence. At this time, there are no drugs that have received this designation.

Prior to the aforementioned requirements, legislation ruled that practitioners, among other factors, need only check the state PMP when prescribing a controlled substance to a patient for the first time, while it is now required for a practitioner to check the system EVERY time when prescribing Schedule II or III drugs.

An example of just how serious Massachusetts is about this crisis, and also believed to be the first agreement of its kind, CVS recently paid almost $800k to the state because pharmacists were not checking prescriptions or the database thoroughly. In exchange, CVS agreed to provide its pharmacists access to the PMP website, train its pharmacists to register for and use the PMP as appropriate, and has further agreed to implement policies that would require pharmacists to consult the PMP before dispensing certain opioids in MA.

Massachusetts and CVS, among many other organizations, recognize the importance of the state’s PMP as a tool to detect and prevent the abuse and misuse of controlled substances. The PMP is not meant to be another government-controlled, green monster hanging on a practitioner’s back at all times; it is meant to serve as a safety extension for practitioners, but most importantly for their patients.

PMP’s can also be most effective when linked with an e-Prescribing solution. Working together, e-Prescribing eliminates the need for paper prescriptions, thus reducing the risk of altered dispense quantities, stolen prescriptions or prescription pads, and the reselling of such prescriptions before they’re filled as a means of lessening the red flags if a patient is doctor shopping.

About DoseSpot

DoseSpot is a Surescriptsâ„¢ certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

DoseSpot Forecast: 3 Segments Positioned for Telehealth Growth

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It’s no surprise that technology should be considered a key player as we shift to value-based care. With smartphones, tablets and computers, health information is readily available for patients with a simple click of a button. Why should a consultation with a healthcare professional be any different?

Telehealth greatly increases the scope of the healthcare industry and is bound to open huge opportunities in increasing the quality of healthcare. The ultimate goal here, is to prevent hospital readmissions through better management of individuals with chronic conditions, while also reducing associated costs. By enabling remote patient monitoring and remote access to clinicians, market growth is inevitable as awareness and implementation of standards for reimbursement and adoptions of these care models expands.

While several reports claim that “technology gets in the way of the patient experience,” patients are in fact the ones demanding such access to care. This increase in patient demand for telehealth services has prompted many companies and healthcare organizations to think outside of the box and reevaluate the patient-centric model, while questioning what that care model really means to a patient.

Well, it’s simple. Patients want a customized, cost-effective and convenient healthcare experience to which telehealth can provide.

A recent report states that the global telehealth market was valued at $14.3 Billion in 2014 and is estimated to reach $36.3 Billion by 2020, growing at a CAGR of 14.30% from 2014 to 2020.

With these numbers in tow, we predict the most growth in three different segments:

Behavioral Health and Addiction

As mentioned in a previous post, telehealth has the ability to bridge the gaps in care of behavioral health patients and providers. Not only does it provide a convenient, more comfortable and less expensive medical consultation, but it broadens accessibility to patients whom may not have many options when seeking a behavioral health provider, especially in rural areas. Unfortunately, the lack of psychiatrists and addiction specialists across the nation, as well as the stigma often involved, are contributing to the mental health and addiction issues and creating barriers to appropriate care.

Patients will see their primary care physician and may not receive the exact treatment plan that they need; after all, primary care physicians do not specialize in behavioral health or addiction and often, these illnesses require a lot of time and patience to which the physician may not be able to accommodate. Telehealth will be able to connect patients in need with specialists regardless of their location who know how to treat these specific health issues.

This effective care model will not only lessen the hit on the nation’s bottom line as more and more individuals grapple with suicide, addiction, and other mental health issues, but also revolutionize the way people view the stigma involved and encourage patients to seek help as they are able to receive treatment from the comfort of their own home.

Geriatric Care

Geriatric patients stand to benefit tremendously as a digital health consumer. As mobility can be especially difficult for these patients, the ability to see a physician remotely removes one of the largest barriers to care. Furthermore, transporting patients of this age may potentially do more harm than good.

With telemedicine, providers can more quickly spot at-risk patients and provide interventions to avoid an otherwise unnecessary hospital admission. Similarly, nursing homes can partner with health systems to provide bedside care for their residents at a fraction of the price of an onsite physician.

These infrastructure synergies provide connectivity with electronic health records (EHRs) and create clear communication among hospitals, senior care facilities, referring physicians and patient families. They also provide the link to population based management databases and other health care analytic functions to measure value.

Surgery

Many surgical departments find telehealth to be a more convenient and cost-effective way for pre- and post- operative instructions for procedures of all magnitudes including wisdom teeth extraction, colonoscopies, stent placement and more.

With in-person visits and paper instructions, patients may misinterpret or even forget important information relative to their surgery. This includes what medications to stop taking and how to physically prepare for surgery, while providing a clear, direct line of answers for any questions a patient may have. With instructions digitally delivered prior to surgery, telehealth reduces patient no shows and saves valuable scheduled operating room time.

For post-op patients, providers can check the patient visually, ensuring that patients are following their treatment plans and making adjustments as needed. Through this continuous connection, providers are empowered to deliver the guidance that many patients need as they go through the healing process. These virtual check-ins ensure the patient is on the road to recovery, thus reducing readmission rates all without the patient ever having to leave their home.

Furthermore, telehealth can improve treatment and medication compliance, specifically with controlled substances, i.e. pain medication. Opioid addiction often begins at the hands of a prescriber and with the nation currently facing an opioid epidemic, marrying technology and follow-up appointments when prescribing these types of medications serves as the optimal solution for the safety of all involved.

Technology should no longer be viewed as a barrier to care, but rather embraced in order to improve the healthcare industry, including the improvement of interoperability as well as patient outcomes. Telehealth not only meets the ever increasing demands of patients, but it also assists in preventative care by creating greater access to such care, thus reducing down-the-road costs and burdensome associated with chronic disease. With many chronic diseases being completely preventable, the prevent vs. treat mantra should be sound in every healthcare professional’s mind, while realizing that telehealth is a seamless way of delivering healthcare for all involved.

There may currently be barriers in place regarding reimbursement from payers, but that’s sure to change as more and more payers jump on board for this new delivery model. After all, who’s to say telehealth won’t become the norm and be known as simply….health?

Sources: American Well; OpenPR; mHealth Intelligence; Healthcare IT News

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

3 Takeaways from Boston’s Opioid Summit and Hack-a-Thon

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Recently, DoseSpot was fortunate to attend Boston’s first ever opioid epidemic hack-a-thon to hear from key opinion leaders in an effort to pitch solutions on how to combat the country’s rising opioid epidemic. Sponsored by the GE Foundation and Massachusetts General Hospital (MGH), the event was comprised of like-minded individuals from all walks of life and specialties, many whom normally wouldn’t sit side by side in the same room until this specific event brought them together. Attendees were given the opportunity to innovate, think differently about this issue and further realize that a significant change is needed in order to tackle this fatal crisis currently grappling our nation.

After attending the summit, the message was clear: we can no longer sit back and believe that there is a one-stop solution. Collective efforts must be put in place and educating and incorporating all components of the healthcare system is imperative to its success.

Here are DoseSpot’s 3 takeaways from the summit:

Opioid addiction does not discriminate

Athletes, politicians, police officers, clinicians, mothers, fathers, siblings, children. Regardless of one’s socioeconomic status, opioid abuse and addiction can affect anyone. In MA alone, there are 4 deaths per day due to opioid overdose and in 2012 there were enough opioid prescriptions to give every American adult their own bottle of pills. However, beyond these statistics are the stories and these courageous stories rang loudly throughout the entire event.

Treat opioid addiction just like any other chronic illness

The stigma associated with addiction often deters people from receiving the treatment they need, and worse, sometimes that stigma is put in place by the very people meant to help them. As many of the speakers at the summit expressed, overcoming stigma should be of utmost priority and addiction should be treated in an effective, mainstream way just like any other condition. Addiction is not a choice; it is a disease.

There needs to be multifaceted solutions to tackle this complex problem

One panelist pointed out that the nation is not thinking big enough or differently enough. Clinicians and healthcare professionals may have blinders on when treating patients, but “one size does not fit all” should be the mantra that everyone utilizes when evaluating their treatment approach. A provider shouldn’t refer to themselves as a one treatment option provider, but utilize all best practices available. As Governor Baker asked, “Wouldn’t you be a better clinician if you expanded your knowledge through a variety of options and techniques?” This includes big data, analytics, e-Prescribing, Medication Assisted Therapy (MAT) and much, much more.

Sources: WBUR; Boston Globe; The Daily Free Press; Boston Business Journal

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.