Pubdate: Fri, 13 May 2016
Source: Press Democrat, The (Santa Rosa, CA)
Copyright: 2016 The Press Democrat
Contact:  http://www.pressdemocrat.com/
Details: http://www.mapinc.org/media/348

FIXING 'BIGGEST MISTAKE IN MODERN MEDICINE'

David A. Kessler, a former director of the U.S. Food and Drug 
Administration, doesn't mince words about assurances from 
pharmaceutical manufacturers that opioid painkillers wouldn't be addictive.

"It has proved to be one of the biggest mistakes in modern medicine," 
Kessler wrote this week in the New York Times.

Opioid use quadrupled between 1999 and 2013, and millions of 
Americans are now hooked on Percocet, Vicodin and other brand-name 
versions of oxycodone, codeine, hydrocodone and fentanyl. Some 20,000 
die each year from opioid overdoses, possibly including the 
entertainer Prince, who was found dead in an elevator in his 
Minnesota home on April 21.

Yet doctors write enough prescriptions each year for every adult in 
the country to be taking these highly addictive drugs.

Why? They're effective in treating acute pain and cancer pain. 
Opioids also are commonly used for end-of-life palliative care.

So the challenge is preventing abuse without causing sick and dying 
people to suffer.

Earlier this year, the Centers for Disease Control recommended some 
new guidelines for doctors who prescribe opioid painkillers. The CDC 
guidelines are voluntary, but they could make a difference if enough 
doctors adopt them.

There may be additional ways to reduce the alarming number of deaths 
caused by opioid abuse.

To that end, Assemblyman Jim Wood, a dentist before his election to 
the Legislature in 2014, is pushing for creation of a state task 
force to develop strategies and policies for curbing the use and 
misuse of opioid painkillers.

"It's about getting all the stakeholders at the table and coming up 
with a plan," the Healdsburg Democrat told Staff Writer Martin 
Espinoza. "Over-prescription is a component. Part of it is 
prescribing patterns, part of it is the amount, part of it is we have 
been pretty permissive about how we prescribe certain medications. 
It's possible that something that isn't a narcotic may serve just as well."

Wood tried to take stronger action. As introduced, his bill would 
have required health plans to include at least one "abuse-deterrent" 
opioid on their drug formularies and prohibit insurers from requiring 
enrollees to first try a non-abuse-deterrent opioid. Some insurers 
were opposed.

The scaled-back proposal to establish a task force cleared the 
Assembly on a unanimous vote and is awaiting a committee assignment 
in the state Senate.

It could be several weeks before autopsy results determine whether 
Prince's death resulted from an opioid overdose. But it already has 
moved discussions about over-prescribing, excessive doses and 
addiction into the public spotlight.

This week, two major health care players - Kaiser Permanente of 
Southern California and Blue Shield of California - announced efforts 
to get physicians to prescribe opioids in smaller amounts, which is 
among the CDC guidelines.

That's a good first step. Others would include physician groups 
dropping their opposition to mandatory training for doctors who 
prescribe opioids and a requirement that doctors and pharmacies check 
a state database of existing prescriptions as a safeguard against abuse.

In the New York Times, Kessler compared opioids to tobacco. "Opioids 
are trickier because they have some value in certain conditions," he 
added. "But we need to view them for what they are: addictive and 
potentially deadly drugs." Lives depend on it.
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MAP posted-by: Jay Bergstrom