63 percent of client households with seniors report making choices between paying for food and paying for medicine/medical care. Two out of five (41%) client households with an adult age 50 and older have at least one member with diabetes, and more than two-thirds (70%) of client households with an older adult have at least one member who has high blood pressure . These rates increase with age. However, among older adult clients, those who are younger report significant health challenges. Fifty-nine percent of those ages 50 to 64 described their own health as fair or poor, a higher rate than that of seniors ages 65 to 74 (53 percent) and age 75 and older (51 percent).
Dr. Ziegler: Prescribers certainly are concerned about prescribing opioids to patients with noncancer pain, but they also are concerned about prescribing opioids to those who are terminally ill. What is best for their patient? The Institute of Medicine and others recognize that pain is individualized; its treatment should be individualized as well.
I would also recommend that prescribers read Responsible Opioid Prescribing: A Clinician’s Guide by Scott Fishman, MD.2 The book covers patient evaluation, treatment plans, informed consent, periodic review, documentation, compliance, etc. Dr. Fishman offers good advice that is straight to the point. As he notes, clinicians should be familiar with state and federal prescribing rules and regulations. State medical or osteopathic associations might be helpful in locating these resources.
Q: Do you think that the reclassification of all hydrocodone combination agents from Schedule III to Schedule II under the federal Controlled Substances Act will help curb opioid abuse?
Dr. Ziegler:No, I do not (of course it depends on how one defines and measures abuse). I recently wrote an article about this topic for Pain View.3< The reason is that drug abuse is a moving target and is an extremely complex social and medical phenomenon. Politically, it may look like the Drug Enforcement Agency (DEA) did something by playing a significant role in the change from Schedule III, but the move will create access problems. This was a broad sweeping reform that has both positive and negative consequences. The action is positive in that it creates a barrier to abuse via more restrictive scheduling, but it is negative because it creates barriers to adequate treatment of pain by reducing legitimate access. The DEA is a law enforcement agency, not a public health agency. Drug abuse and undertreated pain are public health problems, not law enforcement problems.
Q: Can you give an example of a balanced policy on opioid prescribing?
Dr. Ziegler: Yes, New Mexico has decided not to establish a dosage threshold because of concern that such a policy would interfere with the patient-provider relationship. Instead, the state requires a mandatory continuing medical education course covering both prescription drug abuse prevention and the treatment of pain.4-7 Thus, the program is balanced and does not fixate on one problem at the expense of the other. The program was created by several stakeholders—regulators, practitioners, and the public—to ensure balance.
Another example of a balanced approach is Project Lazarus (http://projectlazarus.org)—a public health model that not only focuses on overdose but also provides educational opportunities related to pain treatment.
Genetic Influences on Pain Perception and Treatment
Article discusses genetic influences on pain perception and treatment, including why different people experience pain in different ways.
Balancing State Opioid Policies With Need for Access to Pain Therapies
States are increasingly playing a regulatory role when it comes to opioid medications. Dr. Stephen J. Ziegler discusses balancing the needs
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