Minnesota officials say new guidelines about when to prescribe opioids are more carrot than stick, but eventually doctors who do not follow them may be barred from treating 1.2 million patients on Medicaid health care.
Lt. Gov. Tina Smith said the guidelines will “help prescribers” when deciding when to prescribe the powerful opioid painkillers and how big a dose to give patients.
Opioid addiction, which can lead to heroin abuse, “continues to be driven by over prescribing and misuse of opioids,” added state Human Services Commissioner Emily Piper during a Friday, Dec. 1, announcement of the just-issued guidelines. She said the first 45 days a patient takes opioids are critical to get them weaned from the drug.
While saying “our goal is not to punish doctors,” Piper said that at some point those who do not meet the guidelines will not be able to treat Minnesotans receiving care from the federal Medicaid program, known in Minnesota as Medical Assistance.
Before a doctor is banned from Medicaid, prescribers such as doctors, dentists and other advanced health care providers will receive notices about how many opioids they are prescribing. Doctors generally do not keep track of such statistics.
Speaking at Allina Health System’s Abbott Northwestern Hospital in Minneapolis, Piper said “there are huge variances” in the number of opioid prescriptions coming from doctors. However, she added, different kinds of patients have different needs. For instance, hospice doctors treating dying patients can legitimately use more opioids than doctors treating less serious issues.
Chief Medical Officer Dr. Rahul Koranne of the Minnesota Hospital Association said that guidelines without penalties are a good first step. Organizations such as his will distribute the guidelines so everyone who can write prescriptions will learn them.
The guidelines, which most doctors have not seen, are in a 67-page document.
“Most physicians, if not all, and providers are trying to do the right thing,” Koranne said. “We did not became the best state in quality just by (doing) nothing.”
The guidelines, compiled over 18 months by a task force, are one step in the process of battling opioid addiction, which affects thousands of Minnesotans.
Rep. Dave Baker of Willmar, whose son died of an opioid overdose six years ago, said he will push a bill in the 2018 Legislature to charge drug makers a fee that would collect up to $20 million, which would be used in the drug fight.
Money would go for such things as drug treatment centers and to improve a statewide registry doctors and pharmacies use to see how often a patient has received opioids.
In general, the guidelines call for doctors and others who write opioid prescriptions to:
- Prescribe at the lowest effective dose and duration, no more than seven days for an initial prescription, and three days in some cases.
- Monitor patients closely while on the powerful medication.
- Work to lower addiction risks for patients on long-term therapy.
- Develop a network of other professionals, such as in mental health and pain management experts, to refer patients.
Smith said the guidelines are important, but will do little good without “a significant and sustained investment in prevention, treatment and recovery.”