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Maine doctors write fewer opioid prescriptions



The prescription of opioids in Maine has dropped in the last five years, including a decline of 14.1 percent in 2018. This is a positive sign that the state is fighting for control of an epidemic of substance abuse that causes a daily overdose rate caused by one death.

Since 2013, opiate regulations in Maine have dropped 41.5 percent, according to recent statistics. The decline occurs as Maine and other states apply limits that reflect the increasing recognition of the role of prescription drugs in the opioid crisis.

The decline in Maine at five years was the seventh highest in the country and year-on-year The decline was the twelfth highest among the states and District of Columbia. The nationwide prescription of opioids decreased by an average of 32.9 percent between 201

3 and 2013 and by 12.4 percent in 2018 alone. The country's capital, with 52.3 percent fewer opioid prescriptions in 2018, was the largest decline compared to 2013.

"This is a very significant reduction in the opioid prescription in Maine, and this is a good one in terms of a public health problem Thing, said Dr. Noah Nesin, chief physician of the Penobscot Community Health Center in Bangor. "As the prescribing physician fully engages with his patients and implements a rational and compassionate quality of life program, things are improving In some patients, however, the carpet is pulled out and they have no positive experience. "

In the Nesin Clinic, 77 percent of patients who previously used opioids for chronic pain no longer use it "Multi-faceted" approach that can include therapy, yoga, diet and over-the-counter medications There is no evidence in Nesin that opioids are effective in controlling chronic pain, and opioid medications can cause overdose and lead to a disruption of substance use.

With fewer opioid prescriptions, there are more patients like Drew Floyd of Portland, who was weaned two years ago from opioids for chronic low back pain. Floyd, a patient from Mercy Hospital, had taken a low dose of opioids before the law required her to do so.

Floyd, 38, said she uses a combination of therapy, exercise, osteopathic adjustments, and medical marijuana to relieve her pain.

"Overall, the pain is no worse than taking opioids, and I do not get any more terrible headaches and do not have nearly as many stomach problems," said Floyd Previously, he took Vicodin, Oxycontin and tramadol opioid painkillers. "The pros outweigh the disadvantages."

She said she needed to rest more, which was better for her body. When she takes painkillers, she exaggerates things that ultimately make her feel worse.

Nesin said that patients at the Penobscot Community Health Center who were weaned from opioids have a better quality of life and have generally been successful in controlling their pain.

The total number of opioid prescriptions written in Maine dropped from 1.1 million – or the equivalent of nearly one opioid prescription for every inhabitant of Maine in 2013 – to 646,986 in 2018, according to IQVIA, a health research company in North Carolina.

Overdose deaths in Maine decreased from 417 in 2017 to 354 in 2018. This was the first reduction after years in which the number of overdose deaths increased. Experts warned, however, that there was a connection between prescribing and overdosing on fatalities, as the opioid crisis is a complex issue involving many factors, including whether a state has strong prevention and treatment programs and the availability of illegal opioids such as heroin and fentanyl , [19659002] Nevertheless, the role of prescription medicines in disrupting fuel use is significant. According to the American Society of Addiction Medicine, four in five new heroin users have begun to abuse prescription painkillers.

Gordon Opioid Response Director Gordon Smith said that the most likely reason for reducing drug overdose deaths in 2018 is broader access to naloxone, a life-saving antidote to opioids.

Smith and other experts said Maine's strict prescription law, which came into effect in 2017, is likely to reduce prescription rates.

The law not only sets the prescription limits, but also requires further training courses from the doctors on the Opioid Regulation. These courses have raised doctors' awareness of the dangers of opioids.

"Now virtually every doctor knows he has to be careful about prescribing opioids," Smith said.

Maine was one of the first states that did so to approve strict prescriptive prescriptions for opioids in 2016, and since then 27 other states have passed laws or strict prescription rules, such as. B. Dosage restrictions developed. For example, Maine limits the dosage to 100 mg morphine equivalents per day for non-acute pain, with several exceptions, as in cancer patients.

"Less opioid prescription will clearly correlate with better outcomes in society," said Michael Kleinrock. The research director of the IQVIA Institute for Human Data Science and a Sanford-based physician

Nevada recently approved stringent new prescribing standards, and the state registered a major decline in prescription of opioids by 2018 at 22.5 percent year-on-year.

Kleinrock said it remains to be seen to what extent the prescription opioids will provide the right balance of painkillers in certain patients without, however, contributing to the disruption of substance use and overdose deaths. He expects the prescription to continue to fall and return to the level of early 2000. Currently, the prescription of opioids in the US has dropped to a level reached in the mid-2000s, but is still about twice as high as in the 1990s, before the prescription of opioids for chronic pain became widespread.

Possibly also greater patient awareness may play a role in reducing prescribing.

Dr. Charles Pattavina, head of the emergency department at St. Joseph's Hospital in Bangor, said the patient's attitude to opioids has changed significantly in recent years.

"We've seen more people need fewer painkillers in an emergency departments," said Pattavina, who is also chairwoman of the Maine Medical Association. "With all the well-deserved news about the opioid crisis, many patients seem to be reluctant to dose or prescribe an opioid drug. They prefer to endure pain rather than taking risks.

Kleinrock said that another factor leading to the increase in opiate prescription was shorter hospital stays. Decades ago, patients stayed longer in the hospital after surgery, and by then their pain had often diminished to the point that they did not need a pain prescription. For patients who were discharged one or two days after surgery, doctors prescribed opioids for home use, often excessively often.

"The dynamic is not as simple as prescribing, which leads to addiction, weakening and death, as tragic as they are. It's a lot more complicated, "said Kleinrock.

For example, prevention and treatment programs are crucial, as is the extension of Medicaid, which makes treatment more accessible to patients with drug-use disorders who could not afford treatment and had no health insurance.

Maine introduced the Medicaid expansion and possibly provided thousands of mothers with drug support. Governor Janet Mills makes the response to the opioid crisis one of her highest priorities.

Andrew MacLean, a spokesman for the Maine Medical Association, said the prescription law in some cases "strained the doctor-patient relationship." Since some patients believe that they do not receive adequate pain relief, the law is generally positive by reducing the prescription of unused opioids.

MacLean said that more and more doctors are seeking alternatives to opioids for pain management, and that was helpful as well. [19659002] "The law has probably found the right balance," he said.


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