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Sustaining a delicate balance of care

New drug rules respect varying levels of pain

For the past 12 years, I have had the privilege to participate in the care of palliative and hospice patients. As a pharmacist, I serve on a palliative care team with a physician certified in palliative care, a nurse practitioner, a social worker and a chaplain.

Our goal is to improve the quality of life of patients who have a serious or life-threatening disease by preventing or treating the symptoms and side effects of both the disease and its treatment. We also assist patients and families in making difficult medical decisions, coordinate care with other physicians, guide planning for safe care outside of the hospital and provide advice and emotional and spiritual support. Prescribing opioids and other pain medications often is crucial to our treatment plans.

I am a member of the Prescription Drug Abuse Task Force established by in September 2012 by Indiana Attorney General Greg Zoeller. Our goal is to significantly reduce the abuse of controlled prescription drugs and to decrease the number of deaths associated with these drugs in Indiana (www.BitterPill.IN.gov).

Prescriptions for pain medications have risen dramatically. Misuse, diversion and abuse of prescription pain medications is epidemic, with devastating consequences to individuals and society. Indiana is 16th nationally in opioid drug deaths, and the rate is accelerating beyond the national average.

Youth nonmedical use of prescription pain medications is alarming, according to national surveys and studies on drug use and abuse:

•2 percent of youths age 12 to 18 reported using a prescription pain medication for a nonmedical use within the past month.

•Nearly 1 in 12 high school seniors reports nonmedical use of vicodin.

•Teenagers typically get pain medications from friends and family, who often do not acknowledge that such sharing is illegal.

The Prescription Drug Abuse Task Force represented a wide range of viewpoints: More than 80 state legislators were joined by law enforcement officers, health officials, members of the medical community, pharmacists, representatives from state and local agencies, and educational providers to ensure that both benefits and potential repercussions of any new protocols are carefully considered.

My primary goal was to ensure that palliative and hospice patients do not face any new barriers created to pain management. Opioid medications (e.g., fentanyl, oxycodone, morphine, etc.) often are our best option to relieve symptoms of these patients; we must make sure they are accessible to them.

The Task Force submitted our final version of “Standards and protocols for physicians in the prescribing of controlled substances for pain management treatment” to the Medical Licensing Board of Indiana. The board approved these rules on Oct. 24.

Beginning Dec. 15, physicians who prescribe controlled substances for chronic pain management will be required to check a patient’s controlled prescription history via INSPECT (the state’s drug monitoring system), check urine drug screens, educate the patient and closely monitor their progress. It is a more deliberate prescribing process which adds an additional layer of safety to these medications. To ensure that nursing home, terminal, palliative and hospice patients receive the pain-relieving medications they need, these groups are exempted from prescribing requirements.

The regulations are a good balance – the expectation is that they will minimize some of the risks of pain medication to society without contributing to the suffering of palliative or terminal patients.

Tracy L. Brooks is assistant chair of the Department of Pharmacy Practice at Manchester University and a palliative care pharmacist with Parkview Regional Medical Center. She wrote this for The Journal Gazette.

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