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We have been hearing so much about the opioid crisis in the past few years. It’s all over the news. Sadly, the number of deaths and overdoses from opioid pain killers continue to rise. This has created a crisis in public health in the United States, as the number of deaths per year from opioids has more than doubled since 2015. 

The number of deaths per year due to opioids is more than the number of deaths from AIDS at its peak in the 1980s. Many experts attribute the increasing death rate to an increase in the supply of fentanyl (a very powerful opioid pain killer), which is brought illegally into this country from places like Mexico and China. 

The demand for opioid pain killers is felt to be driven, to a large extent, by doctors prescribing pain killers dating back several decades, which in some instances has led to addiction to opioids. People who become addicted, sometimes turn to illegal sources, when they no longer have access to prescription opioids. Interestingly, when this prescribing trend started, doctors were being encouraged to pay more attention to helping reduce patients’ pain levels, even when the pain was caused by benign conditions such as arthritis and spinal problems.

As a result of this epidemic of deaths from opioid overdoses, many states have enacted legislation to restrict the practice patterns of doctors in order to prevent misuse of painkillers. In Ohio, such legislation is already in place. Gov. John Kasich has taken a strong position, encouraging the passage of these laws. How do these laws affect your doctor’s ability to treat painful conditions?

All physicians have to follow set protocols when issuing any prescriptions for controlled substances. Controlled substances include not only pain killers, but also various other medications including tranquilizers and sleeping pills. In addition, certain stimulant medications used to treat ADHD, as well as appetite suppressants used for weight loss, are included in these restricted categories. So, what is the protocol your doctor has to follow? The rules vary somewhat from hospital to hospital, but in general they are as follows.

Before issuing such a prescription, your doctor may speak to you about the risks and benefits of the medication, as well as possible alternative medications that could be tried and have less risk. In addition, one may search a computer database called OARRS, which was developed by Ohio and other states to track the uses of controlled substances. Pharmacies are required to send this information to the state when they dispense a prescription for a controlled substance. 

When a physician searches for this information online, sometimes so-called “red flags” will become apparent, such as a patient getting prescriptions for painkillers from multiple doctors. If such a red flag in found, then physicians will use extreme caution before supplying any new prescriptions. In addition physicians may request urine testing to check to see if the prescribed medication is actually being used, which can be confirmed with urine testing. Lastly, physicians may ask to have a controlled substance pain contract signed, which involves certain expectations that patients who are being prescribed such medications, will be asked to agree to.

The goal of these policies is to reduce the chance of addiction to prescription opioids and tranquilizers, thereby lessening the chance for accidental overdose deaths.

Dr. Mark Roth writes about internal medicine for the Cleveland Jewish News. He is an internal medicine physician with University Hospitals.  

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