Pain management is about to get more complicated

Pain management is about to get more complicated

Pain management is about to get more complicated

There are over 1,000 people in Winnemucca who are on opioids for pain management, according to information local medical providers shared with Humboldt General Hospital Board members. Many of these patients have been on pain medications for years.

New requirements regarding pain medication, which take effect Jan. 1, 2018, will make prescribing pain medications for these patients more complicated. Some patients may no longer be able to access the medications they are used to receiving,

A new prescription monitoring program will require both doctors and pharmacists to track prescriptions of pain medications classified as schedule 1, 2 or 4. Those monitoring reports will go into a database that will track the opioids each doctor prescribes, which opioid prescriptions are filled at each pharmacy and the exact amount of pain medication each individual is prescribed. The records will track whether patients are following the dosage and frequency prescribed for the medications.

One goal of the tracking will be to make it much more difficult for a person to visit more than one doctor to get multiple prescriptions for opioids. Another goal will be to make it obvious which doctors are over-prescribing opioids.

The new law was the Nevada Legislature's response to concerns about opioid addiction and overdose deaths nationwide. In August, The US Attorney General announced formation of the Opioid Fraud and Abuse Detection Unit, a new Department of Justice pilot program to utilize data to help combat the opioid crisis.

"The law is expecting our provider to wean patients off these drugs," said Sandy Lehman, HGH compliance officer. "You may be hearing some complaints about this."

Lehman said that formerly, medical providers were not required to check the database or record their own prescriptions if they weren't prescribing pain medications for over seven days, or if they knew their patients well. Now both medical providers and pharmacists must do an online check every time a patient is prescribed a controlled substance. She said the database will show if someone was given pills this month in Humboldt County, more pills in Lovelock and more from Battle Mountain.

"If you were prescribed 125 pills for the whole month and it's the 19th, and you're out of pills, there's a problem. You're either diverting them or you're over-using," Lehman told hospital board members.

"Now providers and pharmacies have to check the PMP (Prescription Monitoring Program) and document that it's been checked," said Lehman. Failing to do so can result in loss of medical and prescription drug licensing.

"As a provider, and someone who is caring for the under-served rural population, this is becoming almost catastrophic for what we can and cannot do," said local physician, Dr. Leonard Perkinson, who has served as HGH Chief of Staff during 2017.

Perkinson said a check of clinic records to see who is receiving narcotics shows there are over 1,000 patients receiving narcotic pain medications. "With this legislation and the penalties that are imposed, it's becoming untenable for the providers in rural Nevada to do it," Perkinson told the hospital board.

"We're in a difficult position; we have to keep the doors open and keep providers licensed," Perkinson continued. "There's not a provision for the 75 year-old woman with debilitating osteoarthritis who has to drive to Reno once a month for pain medications.”

Perkinson said the issue of weaning patients off of pain medication is also difficult. He said special training and certification is required for withdrawal management.

Dr Shouping Li in Winnemucca has the necessary certification for withdrawal management but Perkinson said there's no way he will be able to care for the number of patients who need this service.

"Patients are going to be unhappy; they're going to complain," Perkinson told the board. "It's not going to be an easy time to do this and it's not just a Humboldt County problem; it's a national problem."