Assuring individuals who need opiates to manage long-term pain they need not worry about losing their medication, Gov. John Kasich Wednesday announced new rules aimed at curbing the unnecessary prescription of opiate painkillers to manage sub-acute and chronic pain and promoting the use of alternative treatments.
At a Statehouse news conference, Kasich was joined by representatives from the State Medical Board, Ohio Board of Nursing, Ohio State Dental Board and Ohio Board of Pharmacy, all of whom voiced support for the new prescribing guidelines.
While the opioid abuse and overdose epidemic continues, Kasich said that imposing stricter prescribing guidelines has led to a marked decrease in opioid doses prescribed, which he called a "gateway" to addiction. He said he could not change the level of overdoses from fentanyl and "street drugs" aside from continuing to ask law enforcement to stop drug traffickers.
"Don't do street drugs. That's what's driving up the numbers. But that does not mean we are out of the woods. It does mean that we are starting to see an improvement in our communities. We're starting to see less chance of addiction than what we have ever seen before. … That is what we are driving for," Kasich said.
From 2012 to 2017, the number of doses of opioids prescribed decreased by 225 million, nearly 30 percent. Additionally, the state has made it more difficult to "doctor shop" to find prescribers who will overprescribe opioid painkillers, resulting in an 88 percent decrease in doctor shopping.
The new rules announced Wednesday would require physicians to have conversations about and explore non-opioid alternative treatments with patients, create new "safety checkpoints" for patient assessment depending on the potency of the medication in question, and require prescribers to consult with a pain management specialist regarding extremely potent prescriptions that can result in overdoses.
The rules will be adopted by the State Medical Board, Ohio Board of Nursing and Ohio State Dental Board and will go into effect sometime in the fall.
There are exemptions built into the rules; they do not apply to those in hospice care or in terminal situations or those in hospitals or in-patient settings. Additionally, there is no maximum dose or duration of treatment set by the rules.
Kasich and State Medical Board President Robert Giacalone said multiple times that individuals who need opiate medication will not be affected by these changes. Additionally, Kasich said most doctors already have these practices.
"Here's the message: if you have chronic pain, you don't need to worry that your medication will be cut off. The message is, you're going to be treated in a very, very special way -- not that patients aren't being treated that way now. It is going to force people in the medical world to slow down and think about the individual. If you need the drugs and time goes on, we want to take a look and see, is there another way you can have pain relief?" Kasich said.
These rules join rules regarding painkiller prescriptions to treat acute pain that went into effect in September 2017. At the press event, Kasich also said that proposed rules that would place more reporting requirements on drug wholesalers were moving along.
Kasich said these regulations come alongside the need for more work in the scientific community to understand brain chemistry and addiction's effect on it.
"The exploration of the brain, to me, is as important as the exploration of the moon. That's why we have to fund those institutions that do that basic research and our universities and great institutions like the National Institutes of Health," Kasich said.
Sen. Matt Dolan (R-Chagrin Falls) used Wednesday's announcement to promote his SB265, which aims to encourage pharmacists to engage with their patients about the medication and treatment plans.
"I support the goals and the passion of Gov. Kasich to reduce the number of people who become addicted to pain medication. Yet I do not think just legislating the practice of medicine achieves this goal. I believe, as does Gov. Kasich, that we in government should let the medical community decide what is best for a patient living with a 30-year old football injury, or someone who is suffering from bone cancer," Dolan said in a statement.