POINT OF VIEW: Fighting the opioid epidemic in the exam room


The United States is in the midst of a public health crisis. Opioid addiction is taking mothers, fathers and children; destroying lives, breaking up families. The problem is particularly insidious in Florida, which has become a destination for rehabilitative services and sober home living. In the first part of 2016, approximately 2,600 people died from opioid overdoses in the state and the epidemic shows no sign of slowing.

Gov. Rick Scott recently declared a public health emergency over this crisis, which frees up nearly $30 million in federal funds to fight this battle for Floridians. State Surgeon General Dr. Celeste Philip has been directed to keep a standing order of Narcan and naloxone – drugs used to counteract overdoses – at the ready, and Attorney General Pam Bondi, who was recently appointed to President Donald Trump’s Opioid and Drug Abuse Commission, has secured a deal for the two drugs to be purchased at a discounted rate.

The Florida Medical Association (FMA), which represents more than 20,000 physicians in the state and provides them with access to expert advice, support and resources, believes that it’s up to all of us to come together as a community to fight this rampant problem at every level: education, prevention, treatment and recovery services. Physicians can effect positive change by staying educated on best practices and effectively communicating with their patients about treatment protocols for pain management. There is an inherent risk in prescribing highly addictive medications, particularly for patients suffering from severe chronic pain.

The FMA recommends that physicians follow the U.S. Centers for Disease Control and Prevention recommendations for prescribing opioids. This includes starting “low and slow” with dosages and prescribing no more than needed for acute and chronic pain. Physicians also have a responsibility to follow up with their patients, to ascertain effectiveness of treatment and, when necessary, include strategies to mitigate the risk of addiction or overdose.

Florida has established a state prescription drug monitoring program (PDMP) to access and review an individual’s history of controlled substance use before making any decisions on best course of treatment. PDMP data is used by prescribers to avoid dangerous drug combinations that would put a patient at high risk for potential addiction or overdose. This, along with urine drug testing to identify prescribed substances and undisclosed use, prevents pill-seeking patients from “doctor shopping.” The FMA encourages physicians to utilize the database, along with established protocols, protections and research, to ensure that they are able to make appropriate clinical decisions for their patients and prescribe treatments responsibly, safely and effectively.

Physicians have an obligation to educate their patients while developing treatment goals. Treatment does not end when a prescription is written: An open line of communication is necessary to make appropriate clinical decisions and detect signs of opioid dependence.

TIMOTHY J. STAPLETON, TALLAHASSEE

Editor’s note: Timothy J. Stapleton is CEO of the Florida Medical Association.



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