Lancaster Physician Fall 2017 - 13

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Providers Unite

The South Central PA Opioid Awareness
Coalition launched in May. Its inclusion
of multiple health care entities and their
affiliates is an acknowledgement of the
common and pressing challenge we face.
Our goal is to reach out across systems-
from emergency departments to primary
care offices, through obstetric and other
specialty practices and out into community
pharmacies-to promote the safe use of
opioids in our communities.
In our first weeks, we launched a
resource-rich website (www.opioidaware.
org) that aims to get doctors and pharmacists talking about the issues with
colleagues and patients. Major initiatives
include educating patients and providers
about practices and behaviors that can
lead to addiction, encouraging community
members to lock up and properly dispose
of unused prescriptions, and offering
non-opioid alternatives for patients experiencing chronic pain.
By sharing ideas, we can hasten adoption
of successful, evidence-based strategies and
divide the effort of exploring promising
new ventures.

There is
clearly
a need to
accelerate
interventions.

for those who've maxed out a medically
necessary prescription.
Gov. Tom Wolf has estimated 4,500
deaths are possible this year. In Lancaster
County, our coroner reported in September
that we had already surpassed the total
number of drug overdoses for 2016.
 The heroin epidemic's devastating reach
hasn't been lost on my colleagues near or
far, who are willing to look beyond our
typically competitive relationships to find
life-saving solutions.
David J. Simons, DO, FAOCA, president of the Lancaster City & County
Medical Society, says clinicians play a vital
role in reversing the skyrocketing number
of overdoses in south central Pennsylvania.
He believes underlying chronic pain issues
require a united front from caring doctors
who can convince patients to try alternative
therapies instead of doctor-shopping until
they get a new prescription.
"We feel like we need to be part of
this solution, to exhaust all non-opioid
options before jumping to opioids," says
Simons, who is also president of Pain
Specialists of Lancaster. "Physicians now
are understanding the medical dilemma,
assessing the need to prescribe, doing
routine testing and recognizing those more
at-risk for addiction."
Shared messaging, one of the coalition's
first goals, has made those conversations
expected and more accepted by most
patients, Simons says. The tone and
approach of the messaging require careful
balance, however, because opioids remain
a life-changing, fully necessary treatment
option for some patients.

Hospitalizations for heroin or pain
medication overdoses climbed to 3,299
statewide in 2016, up 79 percent from
2014, according to the Pennsylvania
Health Care Cost Containment Council.

Chris Echterling, MD, medical director
for vulnerable populations for WellSpan
Health, says sharing messages about
changing the way opioids are used in pain
management has been critical.

Those statistics don't include the staggering death toll attributed to opioids
and heroin, often an illicit replacement

"When they see it everywhere, it's
more powerful," he says of patients. "It's
not about the individual doctor or the

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PHYSICIAN

individual patient. It's not about a judgment they think we're making based on a
perception of that patient. It's a degree of
standardized messaging that strengthens
our entire effort."
Explaining the problems (a history of
overprescribing, too many overdose deaths,
and fears about the drugs' safety) and
encouraging anti-abuse actions (asking
for non-opioid care plans, locking up
drugs, and disposing of extra medication)
are all patient-forward ways for member
organizations to protect patients without
hurting their own bottom line.
Echterling chairs our coalition's clinical committee, which is tasked with
adopting guidelines to follow. Many of
our protocols are in line with the outpatient-oriented Centers for Disease Control
and Prevention's 2016 Opioid Prescribing
Guidelines (https://www.cdc.gov/drugoverdose/prescribing/guideline.html). When
situations arise that require additional
input-such as how to treat patients in
the emergency room or during in-patient
stays-the subcommittee must agree on
which other well-researched, scientifically
based practices to follow and share with
the membership.
Echterling acknowledges that it can
be hard for regional providers to come
together when they're used to fighting for
patients and revenue.
He suggests others who want to strengthen their opioid addiction response on a
regional level get started by looking for
one "absolute win"-uniform public messaging, for instance-that won't leave any
participating providers at a disadvantage.
Our coalition's charter members-representing all the major health systems in
our seven-county area-worked together
for about four months before publicly
launching the effort.

Continued on page 14
http://www.opioidaware https://www.cdc.gov/drugov
Table of Contents for the Digital Edition of Lancaster Physician Fall 2017
