By FRANK LEWIS
PDT Staff Writer
To curb the amount of opiates being dispensed around the state, Ohio has come up with a new Emergency Room protocol. Tracy Intihar, cabinet director for Gov. John Kasich, said it has been exciting to see the cabinet come together to work on the issue.
“Early on in the administration the governor began to press the (State) Medical Board and the Pharmacy Board to step up and take action and seriously look at what was happening with some of the pill mills,” Intihar said. “And with House Bill 93, that all coupled, really did make some positive forward movement.”
House Bill 93, sponsored by State Rep. Dr. Terry Johnson, R-McDermott, set parameters for the certification and operation of pain clinics. That certification process is one of the factors being credited with the closing of all nine pain clinics that had been located in Scioto County.
“I believe we’ve seen a 10 percent decrease in the number of opiates prescribed in Scioto and Gallia counties. There is movement,” Intihar said. “I think the next focus will be in educating prescribers. We targeted the pill mill providers, Doctors who were really just looking to make a buck, and now we’re going to focus on the doctors who really just need to understand the dangers of opiates.”
Intihar said the Kasich administration believes there is too much “overprescribing,” being done by emergency rooms. She said a team of people who are stakeholders has been looking at the problem.
“The Emergency Department Protocols will soon be announced, and our cabinet, Doctor (Kevin) Winslow at the Department of Health, and Bonnie Kantor-Burman at the Department on Aging, sat down with all the stakeholders and said emergency departments are a big part of the problem,” Intihar said. “So they worked with the stakeholders, the OSMA (Ohio State Medical Association), the Hospital Association, the Association for ER Doctors, and reached an agreement on what emergency departments should and should not do. They shouldn’t prescribe for chronic pain. They should check OARRS (Ohio Automated Rx Reporting System), and fake IDs.”
Kasich said emergency rooms represent a significant number of prescriptions but only 10 percent of total numbers of opiates prescribed.
“You run into the emergency room, you get these prescriptions, and you go out and get these pills. And it’s not anybody that means any malice, but they’re not thinking, ‘wait a minute, somebody is taking that prescription. They’re selling the prescription to somebody else, or giving it to their family,” Kasich said.
Kasich said dealing with the emergency room prescribing of opiates can be used as leverage to get other things done.
“Now you’re talking to the Dental Association and the Medical Association and the Nursing Association, so that we can begin to get a handle on the total amount in the universe of what prescriptions ought to look like,” Kasich said. “So doctors begin to realize the solution is not just to give somebody a prescription for an opiate. That gets to the heart of this problem.”
Kasich said he expects some push-back from the move to control the prescribing of pain medications.
“I’m pleased with where we’re going,” Kasich said. “We’ve made progress. Deaths are down. Prescriptions are down. But I always believe you use good news to get more good news. The good news that we have, we use as momentum to get more good news. It also meant replacing members of the Medical Board and the Dental Board. The Medical Board for years was a sleepy tired old place, and we got some people on that Board, and they’re shaking up the system. It’s great. Lots of changes in lots of different areas, and we’re gonna stay on it.”
The administration also is considering changes with the Bureau of Workers Compensation, which plays a role in medication distribution, Intihar said.
“We looked at Medicaid, too,” Intihar said. “And one important step was requiring those Medicaid recipients and BWC participants to only use one pharmacy, because there was easy doctor shopping going on within those big networks.”
Doctor shopping is the practice of getting multiple prescriptions from multiple sources, and typically for sale or distribution.
“We have had an agreement reached by the emergency rooms, the hospitals that run them, the doctors that participate, and even had the urgent care centers raise their hand and say, ‘we want to participate, too,’” Intihar said. “It really establishes a guideline, and there’s education; commitment to say - ‘here are rules - if you have a lost prescription, we are not just refilling it. We are not writing you a new one. We have the right to check your ID to make sure you are not playing games. We have the right to do a urine screen to.’ We will list out all those guidelines so that it’s clear to the doctors who work there, and the people going in. I think the emergency rooms welcomed it because it helps them to say no.”
Kasich said some of the guidelines may eventually be put into the law, but he prefers to see if the problem can be handled by the voluntary acceptance of the guidelines.
No one from the Emergency Department at Southern Ohio Medical Center was available for comment Friday.
Frank Lewis may be reached at 740-353-3101, ext. 232, or at firstname.lastname@example.org.