Charleston Area Medical Center may consider changing its policies on opioid prescribing in light of new federal guidelines from the Centers for Disease Control and Prevention, hospital officials said Wednesday.
Dr. Glen Crotty, chief operating officer for CAMC, told members of the hospital's board of directors Wednesday that the hospital system would consider placing more stringent limits on what can be prescribed in its emergency rooms, after recent recommendations from both the CDC and the West Virginia Hospital Association cautioned against filling long-term opioid prescriptions.
"We're working on guidelines through the [West Virginia Hospital Association] on distribution of medications in the emergency room, and limiting the number of days a prescription can be written for out of the emergency room, so that instead of 30- and 45-day prescriptions for meds, they're limited to something like five days," he said.
The Centers for Disease Control and Prevention issued new recommendations last week for health care providers on prescribing opioids for treating pain outside of cancer treatment and palliative care.
The guidelines recommend that doctors avoid opioids as a first choice in treating musculoskeletal pain and should attempt to treat pain without medication or without opioid medication. When opioids are deemed necessary, they should be given in the lowest possible dose and with clear plans for how long they will be administered.
According to the CDC, 20 percent of patients who complain of pain not related to cancer are prescribed opioids, and the rates of opioid prescribing vary greatly from state to state without corresponding health factors.
According to prescribing data from the CDC, West Virginia has one of the highest opioid and benzodiazepine prescribing rates in the country, a leading contributor to the opioid epidemic. West Virginia has the third-highest prescribing rate per 100 persons for opioid pain relievers - 137.6 per 100 persons - and has the highest prescribing rate for benzodiazepines in the country - 71.9 per 100 persons. West Virginia also has the highest drug overdose mortality rate in the nation.
"The new CDC guidelines are not directed much toward the hospital management of pain; they're really directed more at pain management in the outpatient setting for those with chronic pain," said board member Dr. James Griffith. "It's to help physicians get a little more conservative and cautious when prescribing long-term, high-potency opiates. Of course, we're running clinics, and I think the guidelines will be helpful in those settings."
In December, the West Virginia Hospital Association developed 10 guidelines, with the help of a task force made up of ER doctors and nurses, that outline the best practices for health-care providers prescribing opioids in hospital emergency rooms across the state.
The WVHA's recommendations included having one physician responsible for prescribing opioids to a given patient, and requiring a patient have a government-issued ID for an opioid prescription. The task force discouraged giving intravenous opioids to treat the "acute exacerbation of chronic pain," and cautioned providers against giving replacement prescriptions for ones that patients claim were lost, stolen or destroyed. They also discourage writing replacement prescriptions for methadone, a drug used to treat opioid addiction, without consulting the patient's methadone program.
The task force recommends ER doctors never prescribe suboxone, another drug used to treat addiction that, like methadone, can be abused, and avoid prescribing opioids to patients enrolled in a suboxone program, except when treating a serious injury like a broken bone. Long-release opioids should not be prescribed in the ER unless the patient is in hospice care, according to the recommendations, and opioid prescriptions for acute injuries and pain should only last roughly 24 hours.
The task force recommends that ER providers develop a treatment plan for frequent patients, and refer patients suspected of opioid abuse to treatment programs or other providers. It also recommends that providers consult the West Virginia Controlled Substance Automated Prescription Program, an online portal that tracks opioid prescriptions in the state, before providing an opioid prescription.
Dr. Gina Busch, an OB-GYN and board member, said the challenge will come with shifting the attitudes of individual doctors when it comes to prescribing the drugs.
"I've never had a problem," she said. "I think it's a knee-jerk thing to give 30 or 40 post-op pills, thinking you won't get phone calls. I give 15, and the number of people who need a refill on their prescription is one or two a year, so I think there are a lot of opioids that are sitting out there that [were prescribed] unnecessarily, and it's a shame."
Reach Lydia Nuzum at lydia.nuzum@wvgazettemail.com, 304-348-5189 or follow @lydianuzum on Twitter.