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Maine doctors writing fewer opioid prescriptions

Opioid prescribing in Maine has plummeted over the last five years, along with a 14.1 percent decline in 2018, a high-quality signal as the state battles to manipulate a deadly disease of substance use ailment that has fueled an overdose rate of 1 loss of life every day.
Since 2013, Maine opioid prescriptions have fallen by way of forty-one. Five percentage, in line with currently released information. The drop is happening as Maine, and different states apply limits that reflect the widening reputation of the role prescription drugs play inside the opioid crisis.

Maine’s five-yr drop become the seventh-maximum inside the united states of America, and its yr-over-12 months decline become the twelfth maximum a number of the states and District of Columbia. Opioid prescribing national fell on average 32.9 percent from 2013-18, and 12 — four percentage in 2018 by myself. The nation’s capital experienced the steepest drop, with 52. Three rate fewer opioid prescriptions in 2018 compared to 2013.

“This is a prevalent reduction in opioid prescribing in Maine, and in terms of a population health trouble, this is a good issue,” stated Dr. Noah Nesin, chief medical officer of Penobscot Community Health Center in Bangor. “To the volume that the prescriber is completely engaged with their sufferers, and conducts a rational and compassionate tapering program, high-quality of life improves. But a few patients are getting the rug pulled out from below them, and they’re now not having a wonderful enjoy.”

At Nesin’s clinic, 77 percent of sufferers who formerly used opioids for persistent ache now-now use them, he stated. They rent a “multifaceted” method that could consist of therapy, yoga, nutrition, and over-the-counter medications. There is not any proof that opioids are effective at controlling continual ache, Nesin stated, and opioid tablets can purpose overdoses and lead to substance use sickness.

With less opioid prescribing, there are greater sufferers like Drew Floyd of Portland, who has weaned off opioids for persistent lower back ache two years in the past. Floyd, a Mercy Hospital affected person, had tapered to a small dose of opioids before the law that would have required her to do so went into impact.

Floyd, 38, said she makes use of a combination of therapy, workout, osteopathic adjustments and medical marijuana to manipulate her ache.
“Overall, the ache isn’t any worse than when I was taking opioids, and I now not get horrible complications, and I don’t have almost as many stomach troubles,” said Floyd, who formerly became taking Vicodin, Oxycontin and tramadol opioid painkillers. “The execs outweigh the cons.”
She said she has to rest extra, that is higher for her body. When she becomes taking painkillers, she would “overdo matters,” which ultimately made her sense worse, she stated.
Nesin said patients at Penobscot Community Health Center who are weaned off opioids have a higher exceptional of existence and have usually been successful at controlling their ache.
The wide range of opioid prescriptions written in Maine fell from 1.1 million – or the equivalent of almost one opioid prescription for every Maine resident in 2013 – to 646,986 in 2018, consistent with IQVIA, a health care research agency in North Carolina.

Drug overdose deaths in Maine declined from 417 in 2017 to 354 in 2018, the first reduction after years in which the overdose death toll mounted. However, professionals advised in opposition to drawing a connection between prescribing and overdose deaths, as the opioid disaster is a complicated problem related to many factors, together with whether a kingdom has robust prevention and remedy packages and the provision of illicit opioids, along with heroin and fentanyl.

Still, the position of prescription drugs in fueling substance use disease is prominent. Four of five new heroin customers commenced through abusing prescription painkillers, in keeping with the American Society of Addiction Medicine.

Gordon Smith, Maine’s opioid reaction director, said the maximum possibly motive for the reduction in drug overdose deaths in 2018 is wider get right of entry to to naloxone, a life-saving antidote to opioids.

Smith and different specialists stated that Maine’s strict prescribing law – which fully went into effect in 2017 – is in all likelihood a contributing issue to prescribing fees declining.
He mentioned that the law not handiest units prescribing limits, but also calls for medical doctors to take persevering with schooling publications on opioid prescribing. Those publications, he stated, have raised focus among physicians of the dangers of opioids.

“Now in reality each prescriber understands they need to be careful when prescribing opioids,” Smith stated.

Maine was one of the first states to approve strict prescribing regulations for opioids in 2016, and on account that then 27 other states have handed laws or evolved strict prescribing rules, inclusive of limits on dosage. Maine, for example, limits dosages to a hundred morphine milligram equivalents per day for non-acute ache, with numerous exceptions, inclusive of for cancer patients.
“Less opioid prescribing will genuinely correlate with better outcomes societally,” stated Michael Kleinrock, studies director for the IQVIA Institute for Human Data Science, and a Sanford resident.

Nevada lately approved demanding new prescribing requirements, and the nation skilled the most significant 12 months-over-12 months drop in opioid prescribing in the kingdom in 2018, at 22.Five percentage.

Kleinrock said it stays to be seen what tiers of opioid prescribing will offer the precise mix of controlling pain for positive patients while no longer contributing to substance use sickness and overdose deaths. He said he expects to prescribe will continue to say no to return to early 2000s stages. Currently, opioid prescribing has plummeted to roughly mid-2000s ranges inside the U.S. But is still approximately twice as familiar because the Nineteen Nineties, earlier than opioid prescribing for chronic pain have become significant.

Increased attention amongst patients also may be gambling a position in reduced prescribing.
Dr. Charles Pattavina, who heads up the Emergency Department at St. Joseph Hospital in Bangor, said there’d been a substantial exchange in patient attitudes toward opioids in latest years.

“We’ve seen greater folks who need less ache medicine in emergency departments,” stated Pattavina, who is additionally chairman of the Maine Medical Association. “Because of all the well-deserved news about the opioid disaster, many patients appear more reluctant to have a dose or a prescription for an opioid medicine. They’d instead placed up with a few aches than take any dangers.”

Kleinrock stated every other thing that brought about the growth in opioid prescribing is shorter hospital remains. Decades in the past, sufferers might live longer within the health center after surgical procedure and using then often their ache had reduced to the factor that they didn’t want an ache prescription. But with sufferers discharged a day or two after surgical treatment, doctors had been prescribing opioids for use at home, frequently for longer amounts than necessary.
“The dynamic isn’t always as simple as overprescribing ensuing in addiction, debilitation, and loss of life, tragic as they are. It’s a lot greater complex than that,” Kleinrock said.

For example, prevention and remedy programs are critical, as is Medicaid enlargement, which makes remedy extra accessible to patients with substance use disorder who couldn’t have the funds for treatment and lacked medical health insurance.

Maine carried out Medicaid enlargement this year, bringing medication-assisted treatment to potentially lots of Mainers. Gov. Janet Mills is making responding to the opioid crisis one in every one of her highest priorities.

Andrew MacLean, a spokesman for the Maine Medical Association, stated even as in some instances the prescribing law has “placed a strain on physician-affected person relationships” because some patients consider they’re now not getting adequate pain remedy, the law is having a common fantastic effect using reducing unneeded opioid prescribing.
MacLean said other docs are pursuing alternatives to opioids for ache management, and that’s additionally been beneficial.

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