Twice as many people in Michigan die from drug overdoses than from car accidents. Let the gravity of that statistic sink in for a moment. Twice as many. And even more startling –about 80% of heroin users previously misused prescription opioids. So it is not surprising to find that Michigan has the tenth highest per capita opioid prescription rate and one of the highest rates of accidental drug overdose in the country! What is being done to address this epidemic?
It may seem like an insurmountable task but the health care industry and the Legislature are responding, attempting to strike a balance between managing patient pain and avoiding over-reliance on highly addictive pills.
Prescribers are taking a more comprehensive and holistic approach. There are improved tools for assessing pain and misuse risk, screening for psychiatric co-morbidities, and determining patient response to opioids. There is a heightened focus on strengthening the physician-patient relationship by building on a foundation of trust. And there is a trend toward more coordinated care among specialties. Safe opioid prescribing is a lot of work –but it is making a difference.
MAPS Overhaul and Related Legislation
Out with the old and in with the new. The old MAPS was a helpful tool in certain respects. It showed us that the prescription of Schedule II drugs (i.e., drugs with high potential for abuse and dependence that also have an accepted medical use) quadrupled in Michigan between 2007 and 2014, increasing from 180 million to 745 million. But the system was not effective in doing much more than collecting data. The information was incomplete because of many exemptions and more importantly, it was not practical as an assessment or monitoring tool for physicians. It could take several minutes to issue a report (compared to 10 seconds for other systems) and crashed regularly. It simply wasn’t a practical tool. The State realized that and purchased a new system.
This new system, to be unveiled April 4, 2017 (registration is now open), is expected to be a significant improvement. It should be faster, easier to use, and more accurate, making it a useful analytical tool for prescribers. The task force recognized that overhauling MAPS was a first, necessary step for additional reforms.
Those additional reforms include the following proposed legislation:
SB 166 and 167: Requires prescribers and dispensers (except during the course of hospice or oncology) to run a MAPS report before prescribing or dispensing.
HB 4284: Allows information sharing with other states, requires prescribers to run a MAPS report before prescribing and at specified intervals; calls for licensing sanctions for prescribing to a patient where the provider has reason to know a patient exhibits “behaviors of concern” (which is defined and includes certain behavior documented within MAPS) without exercising “sound clinical judgment.”
SB 047: Expands reporting requirements to those who administer or dispense directly to a patient (except in an emergency department, an oncology department, a hospital to an inpatient, or a hospice facility) and requires the dispensing of buprenorphine or a combination of buprenorphine and methadone to be reported.
Passage of these amendments, combined with the upgraded MAPS, will result in an increased amount of data made efficiently available to health care providers. Importantly, prescribers would still be able to use judgment in prescribing opioids, but that judgment would need to be based on all of the available data. So, with the MAPS improvements, may come associated requirements to actually use the information or face licensing sanctions.
Additional Anticipated Legislation
The Legislature is not placing the entire burden of relieving the opioid crisis on health care providers, though:
SB 028: Rescinds manufacturer and seller immunity for the manufacture or sale of an FDA-approved drug.
HB 4074: Requires insurance coverage for abuse-deterrent opioid analgesics.
SB 236 / 237: Requires opioid abuse education in schools.
All of this legislation is in the very early stages, and we look forward to watching its advancement. Attacking this epidemic with a collaborative approach will save lives.