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Opioide laws could increase business in Michigan pain management clinics











Dr. Alexander Ajlouni, who specializes in pain therapy, said that new prescriptive opioid prescription laws could lead GPs to refer more patients to clinics like his.

One of the biggest changes, which came into effect on June 1

, requires physicians to review the drug prescription history on the Michigan Automated Prescription System for each patient who has prescribed a three-day offer or more. It prevents patients from buying from the doctor and dangerously combining dangerous drugs.

Ajlouni, affiliated with the McLaren Macomb Hospital at Mount Clemens, supports the new laws but believes that they can produce the unintended consequence of the increasing popularity of pain management clinics. He said some physicians would not want to deal with the extra work of conducting the MAPS research without additional compensation.

Many pain clinics are flooded because many doctors do not want to jump through the tires that the state wants them to get through, said Aljouni. I think some of these (the new laws) are a knee-jerk answer. You have taken away much of the judgment of the doctors.

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Dr. Brett Bielawski, an internist affiliated with the Beaumont Hospital in Troy, agreed that the new laws could produce this consequence, but emphasized that physicians must focus on their primary mission.

Everyone has to return to the basics, a doctor's duty is no harm, he said.

The law requires the review of MAPS if a doctor distributes the prescription substances in any amount. It is part of an 11-bill package passed by state legislation and signed by Gov Rick Snyder to tackle the ongoing crisis of opiate dependence, including prescription painkillers and heroin and fentanyl.

Linda Davis, president of the Fraser-based Families Against Narcotics, said doctors who are passing patients on to new demands are avoiding their responsibilities.

Everyone who asks the doctors should do their job, Davis said. You do not create a problem, then you run away. This is not a way for doctors to stop being doctors.

Another important change takes place on Sunday, which restricts physicians to prescribing a seven-day seven-day care to a patient in acute pain. Chronic pain clinics are not affected by this law.

Some laws came into force on June 1, others came earlier this year or will become law next year. For example, health care providers are also required to advise patients on the risks of opioids and to complete a Start Talking Form before prescribing opioids.

Davis, who is a Judge at 41B District Court in Clinton Township, said the laws, which are in progress for a few years, are critical to the fight against the opioid crisis, leading to a record number of opioid overdoses at national and in Macomb County has led, while the number in Oakland and throughout Michigan has continued to rise.

These laws are necessary because this is an epidemic, said Davis, also a judge at 41B District Court in Clinton Township.

Protecting patients from addiction and overdose risk is the purpose of all the reforms we enact, said Michigan Lt Gov. Brian Calley, the chairman, was the Governor-Michigan Prescription Drug and Opioid Abuse Task Force. By limiting exposure to potentially addictive drugs, we reduce the likelihood that someone will become addicted or potentially overdosed. These efforts also encourage discussions between physicians and patients about how acute pain can be treated most safely and effectively.

Bielawski, who runs a practice in Rochester Hills, said the MAPS requirement has opened many patients' eyes over patients

He said some patients unknowingly could combine two recipes that create a toxic cocktail.

The combination of some or all of these drugs can be fatal, he said. Many people are unaware that the combination of Xanax and hydrocodone (an opioid) can cause an overdose.

MAPS is one of the many preventive agents used in our fight against the opioid epidemic, said Kim Gaedeke, deputy director of the Department of Licensing and Regulatory Affairs. The use of MAPS by prescribers and dispensers will provide the clinician with a more robust analysis and insight into the risk of possible substance disorder or other health concerns when prescribed a controlled substance

Ajlouni, who also practices in St. Clair Shores clinics Shelby Township, when it first began pain therapy 25 years ago, used about 10 to 15 percent of its patients for opioids. Today, almost all of his new patients come to him and already take opioids for pain.

He spends much of his time relieving patients of opioids and other methods of treating pain, including over-the-counter medications, nerve treatment, spinal stimulation, steroid injection, exercise, and physical exercises.

It has been much less fun in my practice, he said. In a way, I'm like a jailer. Now I am the bad policeman. I have patients pee in a cup. I ask them.

But he said that it pays off because of the results, since he gets about a third of opioids.

Over time, I can reduce their dependence on opioids, but it involves a lot of hand-holding. A lot of work has to be done, he said. We as Americans are always on the lookout for a quick fix (with opioids). But there are many better options for treating chronic pain than opioids.

For more information about MAPS, see Michigan.gov/MiMAPSInfo.


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