Mass. Medical Society issues opioid prescription guidelines

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By Emily Micucci

The Massachusetts Medical Society has kicked off a campaign aimed at promoting safe opioid prescription practices among Bay State physicians, the latest in a collection of efforts by health care stakeholders to reduce the availability of opioids.

The new guidelines, available on the Massachusetts Medical Society website, are intended to reduce the supply of opioids, which are frequently accessed by people other than the patients to whom they’re prescribed, said Dr. Dennis Dimitri, president of the medical society. Dimitri cited statistics from the national Centers for Disease Control that more than 80 percent of people who abuse painkillers are using medicine prescribed to someone else.

Guidelines defer to docs' judgement

“By limiting this supply and ensuring that opioids are available only to patients who truly need them, we can make a big impact on the commonwealth’s opioid crisis,” Dimitri said in a statement.

But Dimitri, who is vice chair of the Department of Family Medicine & Community Health at UMass Memorial Medical Center in Worcester, said the campaign is meant to set guidelines, not hard-and-fast rules, around prescribing painkillers. He noted, too, that most doctors act responsibly when prescribing medicine to treat pain.

“The bottom line is that physicians still need to use some judgment around individual cases,” Dimitri said in an interview following the announcement of the campaign.

While opioids can be addictive, their benefits for patients with acute pain should not be minimized, Dimitri said. Cancer patients and those who have recently undergone surgery, as well as the terminally ill, are often helped greatly by these drugs, he said.

“We’ve known for a long time they’re very important medications to relieve pain and suffering, which is an important part of the doctor’s job,” Dimitri said.

The medical society, an industry association representing about 25,000 Massachusetts physicians, drafted the guidelines based on recommendations from a group of doctors who are experts in pain management, as well as doctors who specialize in addiction. They address best practices for prescribing opioids for patients with acute and chronic pain separately. For those with acute pain, the focus is on prescribing the minimum dose necessary to reduce pain, over a short period of time. For those with chronic pain, the medical society emphasizes the use of opioids as part of a comprehensive pain management strategy, and recommends that doctors evaluate patients’ use of opioids every 60 to 90 days while screening patients for addiction and maintaining treatment agreements with their patients that set goals for reducing pain and defining the circumstances in which patients may obtain opioids from other prescribers.

The campaign also includes educational resources for providers who prescribe painkillers, as well as information on safe storage and disposal to be shared with patients in their families.

The new guidelines add to similar policy-making efforts around opioid prescriptions, including those by the Massachusetts Hospital Association, which is seeking to curb the over prescription of opioids at Bay State hospitals, starting in emergency rooms.

Blue Cross Blue Shield of Massachusetts, the state’s largest insurer, has also implemented new opioid prescription authorization requirements that make it more difficult for patients to receive opioids on an ongoing basis.