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Archive for December, 2017

Opioids in America: A National Epidemic – And a Local Problem

Thursday, December 21st, 2017

By Sandra Adamson Fryhofer M.D., MACP, FRCP Member, MAA Board of Directors and MAA Opioid Task Force

Each day, more than 90 Americans overdose and die from opioids.1 more than quadrupled from 1999 to 2015.2 And the amount of opioids prescribed tripled since 1999.3 These are deadly, disturbing statistics.

Recent stats from the National Survey on Drug Use and Health (2015)2 further emphasize the magnitude of the problem:

• More than one third (38 percent) of all US adults (nearly 92 million) used prescription opioids.2

• 5 percent (more than 11 million adults) misused them (taking them without a prescription, or longer, more often or in greater amounts than recommended by their physician).2

• 1 percent (nearly 2 million adults) had opioid use disorder.2

Fact versus Myth

This is mainly a rural problem. False. Opioid use and misuse is just as common in urban and suburban areas as in rural areas.2 As highlighted recently in The Washington Post, rural areas do have additional challenges: fewer healthcare professionals to treat addicted patients and longer travel distances for first responders.4

Socioeconomic factors play a role. True. Adults with low incomes, as well as those without a job, were not only more likely to misuse opioids but also more likely to have an opioid use disorder. The same goes for those with behavioral health problems. Adults without health insurance were twice as likely to misuse opioids.An accompanying editorial in Annals suggests that having health insurance should provide ways – other than opioids – to deal with pain.5 But even those with health insurance, higher income and higher education are still at risk.5 No strata of society has been spared.5

Most people misuse opioids to get high. False. Most people (64 percent) who misuse opioids do so to relieve physical pain.About 22 percent use them to relax (11 percent) or to get high (11 percent).2

The longer you take opioids, the greater the risk of use disorder, overdose and death. True. Taking even low doses of opioids for more than 90 days increases odds of opioid use disorder by a factor of 153.

Reducing opioid prescribing leads to increases in heroin use. False. In a recent JAMA viewpoint, Drs. Schuchat, Houry and Guy dispel this myth by citing evidence that state policies aimed at reducing amounts of opioids prescribed reduce both opioid-involved deaths and heroin overdose deaths by reducing initial opioid exposure, thus reducing addiction risk.3

Physician prescriptions are the source of the majority of opioids that are misused. Half true. Although family and friends were the source of free drugs for more than 40 percent of opioid misusers, 86 percent of those misused opioids were diverted to the misuser from prescriptions prescribed (to the misuser’s friends and family) by physicians.2 This means that many of our patients are giving away pain meds, not realizing the dangers and long-term consequences.

“The cycle of prescribing opioids begins with clinicians.”3 Our Georgia state legislature and composite state medical board seem to think so. On May 4, 2017, Gov. Nathan Deal signed into law HB 249 to address the opioid problem in the State of Georgia.6

This new law moved the Prescription Drug Monitoring Program (PDMP) from the Georgia Drugs and Narcotics Agency to the Department of Public Health. It also contains several requirements that directly affect Georgia physicians. To address this issue, the Medical Association of Atlanta’s (MAA) Board of Directors assigned a Task Force to create an Opioid Resources webpage: End the Opioid Epidemic on the MAA website at maa-assn.org.7 It includes the new requirements, deadline dates and links to resources to help physicians comply. The three new requirements are:

1. PDMP Requirement

New state requirements include PDMP sign up (mandatory as of
January 1, 2018), PDMP check and every 90 day re-check (mandatory as of July 1, 2018):

• The PDMP check requirement applies to prescriptions for all benzodiazepines but only to those opioids listed in in paragraphs 1 and 2 of § 16-13-26 Schedule II list.8 The list includes commonly prescribed opioids such as hydrocodone (Vicodin, Lortab, Zohydro), oxycodone (OxyContin and Percocet) and morphine.12 10

• The PDMP check requirement does NOT apply to non- benzodiazepines including non-benzodiazepine sleeping pills: Zolpidem (Ambien, Intermezzo, Zolpimist), Eszopiclone (Lunesta), Zaleplon (Sonata) – since they are NOT benzodiazepines.9 The PDMP check requirement does apply to all benzodiazepines 9 Since Estazolam (Prosom), Flurazepam (Dalmane), Temazepam (Restoril), Alprazolam (Xanax), Chlordiazepoxide (Librium), Clonazepam (Klonopin), Diazepam (Valium), Lorazepam (Ativan) and Oxazepam (Serax) are benzodiazepines,9 they are included on the PDMP required checklist.

• Although checking the PDMP may be delegated to two members of your staff (registration by Georgia Board of Pharmacy required for unlicensed staff), any unauthorized use of PDMP data by a delegate can result in civil or criminal penalty for you, “the prescriber.”6

• PDMP checks must be documented in the patient’s chart.6

2. Patient Education Requirement

In addition, HB 249’s provision for mandatory (oral or written) patient education on opioid addictive risks and safe disposal when prescribing opioids became effective as of July 1, 20176 Links to free patient educational materials (in English and Spanish) are also on the new MAA Opioid Resource webpage.7

3. CME Requirement

The Composite State Medical Board now requires at least 3 hours of safe opioid prescribing CME prior to obtaining or renewing your medical license (effective January 1, 2018). Our MAA webpage has a link to a free CME course that will fulfill the Board’s CME requirement.11

Although these new requirements present an additional administrative burden for physicians, they are now law, and we must comply. Although the requirement cannot “cure” the problem, they do shine a spotlight on the issue of opioid prescribing, use and misuse and increase awareness of the problem.

MAA’s Opioid Resource webpage7 also contains links to the Medical Association of Georgia’s Think About It and Project DAN-Deaths Avoided by Naloxone initiatives, AMA’s End the Epidemic website, the Surgeon General’s Turn the Tide website, additional opioid resources from the CDC, as well as a bibliography of recent references and scholarly articles addressing opioid use and misuse.7

Already, we are beginning to see some encouraging prescribing trends as revealed in a new AMA report: “Between 2012 and 2016, the number of opioid prescriptions decreased by more than 43 million – a 16.9 percent decrease nationally. Every state saw a decrease in opioid prescriptions during this period.”12

Helping those already afflicted with opioid use disorder is also important. Gov. Deal also signed into law SB 88,13 the Narcotic Treatment Programs Enforcement Act, requiring the Department of Community Health to specify minimum standards and quality of services for narcotic treatment programs seeking licensure in Georgia.

Going forward, more research and resources are needed as we respond to this national emergency. Physician involvement is and must remain a critical part of the solution. On that, the Medical Association of Atlanta can be a vital resource for you and for the health of your patients.


References

1. Volkow ND, Collins FS. The Role of Science in Addressing the Opioid Crisis. New England Journal of Medicine July 27, 2017: 391- 94.

2. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. [Epub ahead of print 1 August 2017] doi: 10.7326/M17-0865

3. Schuchat A, Houry D, Guy GP. New Data on Opioid Use and Prescribing in the United States. JAMA.2017;318(5):425–426. doi:10.1001/jama.2017.8913

4. Humphreys K. Opioid abuse started as a rural epidemic. It’s now a national. Washington Post, accessed on September 3, 2017. Available at: https://www.washington- post.com/news/wonk/wp/2017/07/31/opioid-abuse-started-as-a-rural-epidemic-its- now-a-national-one/?utm_term=.c9eb36351499

5. Lasser KE. Prescription Opioid Use Among U.S. Adults: Our Brave New World. Ann Intern Med. [Epub ahead of print 1 August 2017]doi: 10.7326/M17-1559

6. 2017-2018 Regular Session – HB 249: Controlled substances; collect more information regarding dispensing and use; provisions, Available at http://www.legis. ga.gov/Legislation/en-US/display/20172018/HB/249 Accessed on Sept 3, 2017.

7. Medical Association of Atlanta website, Opioid Resources Webpage: End the Opioid Epidemic, Available at http://www.maa-assn.org/?page=OpioidEpidemic Accessed on September 3, 3017

8. Link to § 16-13-26 Schedule II list of controlled substances: Please note that HB 249 applies to drugs listed in Paragraphs 1 and 2 of this schedule : http://law.justia. com/codes/georgia/2010/title-16/chapter-13/article-2/16-13-26

9. List of Sedative-Hypnotic Drugs (Sleeping Pills) eMed Expert website. Available at http://www.emedexpert.com/lists/sedative-hypnotics.shtml Accessed on September 3, 2017.

10. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults. Ann Intern Med. [Epub ahead of print 1 August 2017] doi: 10.7326/P17-9042

11. Notice of Intent to Amend and Adopt Rules. Georgia Composite Medical Board website (Rule 360-15-.01. Requirements for Physicians). Available at https://medi- calboard.georgia.gov/sites/medicalboard.georgia.gov/ les/intent%20360-15-01.pdf Accessed on September 3, 2017.

12. Physicians’ progress to reverse the nation’s opioid epidemic. Available on the Medical Association of Georgia website at http://www.mag.org/sites/default/ les/ downloads/AMAOpioidTaskForce2017progressreportMay2017.pdf Assessed on September 7, 2017.

13. Deal signs opioid legislation. State of Georgia website. Available at https://gov. georgia.gov/press-releases/2017-05-04/deal-signs-opioid-legislation Accessed on September 3, 2017.

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Emory Sports Medicine Center and Emory Physical Therapy Center Open

Thursday, December 21st, 2017

This month, the Emory Sports Medicine Center and Emory Physical Therapy Center located within the Emory Sports Medicine Complex officially opened to patients. The 90,000-square-foot complex is the first of its kind, integrating four state-of-the-art facilities on its five-acre campus:

Emory Healthcare Courts
Emory Healthcare Courts serves as the official practice and training facility for the Atlanta Hawks. With an emphasis on player development, peak performance and comprehensive player care, it features two full-length basketball courts with direct access to expanded athletic performance training areas, a film room, and a fully-dedicated recovery area including cryotherapy, sensory deprivation tanks and in-ground hydrotherapy. The Hawks Basketball Operations Team is housed in the facility full-time.

Emory Sports Medicine Center and Emory Physical Therapy
Emory’s entire sports-medicine division operates within this facility, giving the Hawks immediate access to Emory’s physicians. The most advanced technology in preventative and rehabilitative treatment and sports performance training including the 3 Tesla MRI scanner, diagnostic imaging technology, recovery technology, 3-D motion capture analysis, and blood/sweat testing and analysis are all on-site. Emory doctors can see their patients at the facility and in conjunction with the Hawks, they will host events to engage the local community.

Peak Performance Project
Commonly referred to as P3, Peak Performance Project is a world-leader in applied sports science based in Santa Barbara, CA. The Atlanta branch is P3’s first location outside of Santa Barbara and serves as its East Coast headquarters. P3 services elite-level athletes from around the world, integrating sports science to assess athlete movement and performance and prescribe individualized optimization plans.

The privately-funded complex was designed by HOK, a global design, architecture, engineering and planning firm with 23 offices worldwide. Atlanta-based construction and management firm H.J. Russell & Company, in association with Legends Project Development, served as the project management team for the project and Brasfield & Gorrie General Contractors was selected to serve as construction manager.

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Four Georgia Scientists Awarded Breast Cancer Research Awards

Thursday, December 21st, 2017

Three breast cancer researchers from three different universities in Georgia have been awarded $50,000 each and a fourth awarded $25,000 thanks to funding from It’s The Journey and The Georgia Center for Oncology Research and Education (Georgia CORE). The two non-profits teamed up to provide $175,000 to recognize creative ideas that may advance progress toward detecting, treating or curing breast cancer.

Awardees of $50,000 include:

Susan Thomas, PhD, Assistant Professor, Institute of Bioengineering and Biosciences, Department of Mechanical Engineering, Georgia Institute of Technology; Mandi Murph, PhD, Associate Professor, Department of Pharmaceutical and Biomedical Sciences, University of Georgia; and Aneja Ritu, PhD, Adjunct Professor, Center for Inflammation, Immunity and Infection, Department of Biology, Georgia State University.

$25,000 was awarded to Dora Il’yasova, Associate Professor of Epidemiology and Biostatistics, School of Public Health, Georgia State University.

Dora Il’yasova

“We had several excellent applicants and feel confident that our reviewers have selected sound, creative ideas of scientific importance for the 2017 Breast Cancer Research Awards,” says Laurel Sybilrud, Chairman of the Board for It’s The Journey.

All research plans are based on national research priorities.

“This one-year pilot funding supports investigators in achieving proof-of-principle,” says Nancy Paris, President and Chief Executive Officer of Georgia CORE. “We support the researchers’ efforts to establish that an idea, invention or process is feasible, so that they can move forward in applying for more extensive funding.”

Georgia CORE oversees the scientific review process in collaboration with the Georgia Research Alliance. (GRA) Rating criteria included scientific importance, innovation, potential impact, investigator and institutional capacity, collaboration and inclusion of disparate populations.

The 2017 Atlanta 2-Day Walk for Breast Cancer, which took place the weekend of November 11-12, enables It’s The Journey to support breast health programs across Georgia. Since 2003, It’s

The Journey has raised $13 million and awarded 298 grants.

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Emory Orthopaedics and Spine Center Offers New Carpal Tunnel Treatment

Thursday, December 21st, 2017

A patient at the Emory Orthopaedics and Spine Center recently became the first in Georgia to receive treatment for carpal tunnel syndrome with the SX-One MicroKnife™ surgical device. The device, which uses technology developed at the Mayo Clinic, is designed to allow physicians to perform carpal tunnel release (CTR) surgery through a single micro-incision (4-5 mm) guided by ultrasound. The technology protects sensitive anatomy when cutting the transverse carpal ligament.

Kenneth Mautner, MD, a non-surgical sports medicine physician at the Emory Orthopaedics and Spine Center, performed the procedure.

“This is an exciting alternative for patients who suffer from carpal tunnel syndrome but have hesitated to have surgical treatment due to long recovery and rehabilitation or unattractive scarring,” says, Mautner, who is considered a national leader in ultrasound- guided procedures.

Carpal tunnel syndrome affects more than 12 million Americans and results in 500,000 surgeries every year. It can be debilitating if left untreated. Traditional CTR procedures can remedy the condition but may result in large and sometimes painful scars, ongoing palmar pain and a long road to recovery.

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News from the 2017 American Society of Hematology Annual Meeting

Thursday, December 21st, 2017

The American Society of Hematology (ASH), the world’s largest professional society concerned with the causes and treatment of blood disorders, hosted more than 25,000 attendees from around the world to highlight groundbreaking scientific research and the latest advances in patient care at its 59th annual meeting this December at the Georgia World Congress Center.

The 2017 ASH Annual Meeting featured nearly 5,000 scientific abstract presentations in malignant and non-malignant blood diseases – from cutting-edge advances in gene therapy to practice-changing discoveries in immunotherapies.

“The ASH Annual Meeting has always been the premier event for serving a global community of hematologists and health professionals,” said ASH President Kenneth C. Anderson, MD, of the Lebow Institute for Myeloma Therapeutics and Jerome Lipper Myeloma Center at Dana-Farber Cancer Institute in Boston.

News that came out of the ASH Annual Meeting included:

Late-Breaking Clinical Trials Signal New Therapeutic Options for Many Patients in the Near Term
In four clinical trials, researchers report promising results suggesting patients with blood disorders and several types of cancer will soon have significantly expanded options for treatment.

Targeted Therapies Show Promise for Improving Outcomes Across a Spectrum of Hematologic Malignancies
Four studies highlight the multiple ways in which novel targeted cancer therapies are now being deployed to improve outcomes and quality of life for patients with rare, advanced, or difficult-to-treat blood malignancies.

People Aged 75 Years and Older Are Underrepresented in Blood Cancer Clinical Trials
In the first comprehensive analysis of clinical trial enrollment among older adults with blood cancers, researchers from the U.S. Food and Drug Administration (FDA) found significant gaps in participation among those aged 75 and older when considered against the incidence of these malignancies in this age group.

CAR T-Cell Therapies Drive Outcomes in Lymphoma, Myeloma
Three studies spotlight the emerging role played by chimeric antigen receptor (CAR) T-cell therapies in helping individuals mount a clinical response and, in some cases, achieve durable remission.

New Therapies Improve Outlook for Bleeding and Clotting Disorders
Researchers report remarkable benefits from new, more easily administered therapies for bleeding and clotting disorders.

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Georgia Neurosurgical Society Annual Fall Meeting

Friday, December 1st, 2017

December 1-3. The Ritz Carlton Reynolds , Lake Oconee, Greensboro, GA. For more information, visit the Georgia Neurosurgical Society.

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MAA – MAG Foundation Distracted Driving Forum

Saturday, December 2nd, 2017

December 2. Woodruff Health Sciences Center Administration Auditorium, Atlanta. For more information, visit Medical Association of Atlanta

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