Minn. Sets Limits on Doctors' Opioid Prescriptions

Minn. Sets Limits on Doctors' Opioid Prescriptions

News Nov 17, 2017

Nov. 17—In Minnesota's latest effort to combat the abuse of prescription painkillers, a state task force has set new limits on opioid prescriptions by doctors who participate in the state's Medicaid program.

The rule, adopted Thursday by the state's Opioid Prescribing Work Group, says that doctors who exceed a new state dosage limit for more than half their patients would receive warnings and training. If they don't bring their dosage amounts down, they would eventually face removal from the Medicaid program, which covers roughly 20 percent of Minnesota's population and has broad influence on providers.

For nonsurgical physicians and dentists, the limit says that no more than half of their opioid prescriptions should exceed the dosage level of 100 morphine milligram equivalents (MMEs). That would be 20 Vicodin or Percocet pills at the common 5 milligram strength. The task force set a similar policy for surgeons, but at a threshold of 200 MMEs per outpatient prescription.

While doctors can always issue second and third prescriptions, studies have shown that many patients get over acute pain from injuries or surgeries with only small initial dosages of opioids, said Dr. Chris Johnson, an Allina Health physician who leads the task force.

"You... don't need near as much as you think you do," he said.

The task force was formed in 2015 in response to a spike in Minnesotans dying from overdoses of prescription opioids such as oxycodone and illicit versions such as heroin. A Star Tribune review of state death records found 402 linked to opioids in 2016—more than double the number in 2006.

The task force limits will take effect on approval by the state human services commissioner. They will apply only to prescriptions made in outpatient settings for the management of short-term, or acute, pain. And they will govern only prescriptions covered by the state Medicaid programs for the poor and disabled.

Thursday's decisions were based on an analysis of 2016 Medicaid data regarding patients who received opioids for the first time.

The analysis found that among emergency room doctors, 27 percent of outpatient prescriptions to Medicaid patients exceeded the 100 MME level.

But one in eight ER doctors exceeded that amount in at least 67 percent of their opioid prescriptions.

Continue Reading

The data also showed the frequency with which doctors prescribed opioids.

On average, primary care doctors issued first-time opioid prescriptions to 2 percent of their Medicaid patients. But for one in eight doctors, that prescribing rate exceeded 8 percent.

The task force decided to monitor nonsurgical doctors and prescribers who exceed that 8 percent threshold.

The research basis for limiting dosage amounts is much stronger than the research for limiting the percentage of patients who receive opioids from a physician, said Dr. Jeff Schiff, medical director of the state's Medicaid program. Some doctors simply have more pain patients who would legitimately qualify for opioids, for example.

Task force members said the new targets also would need to come with exemptions for doctors whose practices require them to prescribe opioids in larger quantities.

Still to come from the task force are limits on the prescribing of opioids for chronic pain. That is controversial, because some patients have become dependent for months or years on opioids to manage pain, even though there is little medical evidence that opioids work for that purpose.

Star Tribune (Minneapolis)
The new fire station would have housed another ambulance, two more firefighters, and be able to fit modern fire trucks to fit the needs of the growing town.
For the first time since 1995, Starkville Fire Department hired a female firefighter, Bethany Allen, who is working on completing her fire academy and EMT training.
To better understand and treat the patients they revive with Narcan, firefighter-EMTs received training on opioid abuse and recovery
The collaboration supports rural healthcare providers with the goal of improving patient outcomes in Kansas through the Redivus mobile clinical decision app.
Children and young adults with Type 1 and Type 2 diabetes could be up to seven times more likely to die from sudden cardiac arrest than those who don't have diabetes.
Deputy Chief State Fire Marshal Sander B. Cohen and Supervisory Special Agent Carlos Wolff were struck and killed Friday on I-270 after Cohen stopped to help Wolff after crashing his car.
Ticket sales from the Jets' recent home game will partially fund EMSCNJ's new 9/11 monument in Keansburg, NJ.
The 'Flying Eye Hospital' features exam equipment and an operating room and travels to developing countries to treat patients with blindness or eye diseases.
Allina Health EMS welcomes newcomers Joan Mellor as Director of External Affairs and Jim Soukup as the Communication Center Director.
Delray Beach wants artists to paint murals on the unsightly garbage trucks being used to barricade large outdoor events in light of the increased use of vehicles as weapons to plow into crowds.
Police have suspect Akayed Ullah in custody, who was badly injured by the bomb he detonated that injured 3 others in the Port Authority bus terminal.
Time is brain, and the Lucid System, which will eventually be tested in ambulances, could save valuable time when diagnosing and treating stroke victims.
Ben Abbott, a two-year member of Wiltshire Air Ambulance, is mentoring his new crew member James Hubbard.
Team Rubicon, a nonprofit group composed of military veterans, first responders, and doctors, has 229 volunteers deployed in Puerto Rico, where health conditions among citizens are worsening.
San Diego Fire-Rescue Chief Brian Fennessy said two of the four passengers were not able to be rescued when the plane became engulfed in flames.