2017 Erin Jackson For presentation at IPTA Revitalize

Transcription

1 Slide 1 The Opioid Epidemic & Physical Therapy Presenter: Erin K. Jackson, JD, MA 2017 CONFERENCE & EXPO Slide 2 Plan Hour one: Overview of the epidemic Hour two: Legal and ethical obligations Hour three: #ChoosePT campaign Please hold your questions for the end. Slide 3 Speaker Introduction Conflicts of Interest Disclosure: None to report. Honoraria received from Illinois Physical Therapy Association Professional Affiliations: Jackson LLP Healthcare Attorneys Jackson Compliance LLP, Healthcare Business Consultancy Inspire Santé, NFP

2 CITATIONS: Acetaminophen/hydrocodone Prices, Drugs.com (last reviewed Mar. 15, 2017). Chris Core, For a stiff neck, nearly $6,000 in physical therapy seemed too much, Washington Post (Aug. 5, 2013). List of Countries with Universal Healthcare, True Cost Blog (last updated Jan. 21, 2013). Nora D. Volkow et al, Medication-Assisted Therapies Tackling the Opioid-Overdose Epidemic, 370 N. Engl. J. Med (May 29, 2014). Laxmaiah Manchikanti et al, Opioid Epidemic in the United States, 15 Pain Physician J. ES9 (2012). ScienceDaily, Chronic pain costs U.S. up to $635 billion, study shows (Sept. 11, 2012). Citation: Richard Miech, Prescription Opioids in Adolescence and Future Opioid Misuse, 136(5) Pediatrics e1169 (Nov. 2015). Cicero TJ et al, The changing face of heroin use in the United States: a retrospective analysis of the past 50 years, 71(7) JAMA Psychiatry (2014). Laxmaiah Manchikanti et al, Opioid Epidemic in the United States, 15 Pain Physician J. ES9 (2012). Eric Newhouse, VA Says 68,000 Vets Addicted to Opioid Painkillers, Psychology Today (Jan. 23, 2017). Sarah Childress, Veterans Face Greater Risks Amid Opioid Crisis, FRONTLINE: Chasing Heroin (Mar. 28, Substance Abuse and Mental Health Services Administration (SAMHSA), 1 in 15 Veterans Had a Substance Use Disorder in the Past Year, The CBHSQ Report (May 7, 2015). Sarah G. Mars, Every Never I Ever Said Came True : Transitions from opioid pills to heroin injecting, 25(2) Int. J. Drug Policy 257 (Mar. 2014). Slide 4 Defining the Opioid Epidemic Drugs include: fentanyl, oxycodone, hydrocodone, morphine, tramadol 16,000 deaths annually from prescription opioid overdose Nearly 500,000 ER visits for opioid overdose US consumes more narcotic pain medication than any other country CITATION: Laxmaiah Manchikanti et al, Opioid Epidemic in the United States, 15 Pain Physician J. ES9 (2012). Slide 5 Defining the Opioid Epidemic Hypothetical: An uninsured, cash-paying patient has significant pain. You re making a 4-month treatment plan. Should s/he be treated with opioids or physical therapy? Option One: Pills 1,000 Acetaminophen/Hydrocodone 325/5mg pills = $376 cash Maximum dose = 8 pills / day, so that prescription will last 125 days Option Two: PT 1 PT visit per week for 125 days = 18 visits 18 visits at $120/hour = $2,160 cash To stay under the $376 cost, each visit needs to cost $20.80 cash Slide s >80% of heroin addicts began heroin use without prior nonmedical opioid drug/pill use Pills Heroin 2000s Trend has flipped, with most heroin addicts reporting nonmedical use of opioid pain relievers prior to heroin use

3 CITATIONS: Nat l Institute on Drug Abuse, Drugabuse.gov, Heroin use is rare in prescription drug users (last updated Dec. 2015). Cicero TJ et al, The changing face of heroin use in the United States: a retrospective analysis of the past 50 years, 71(7) JAMA Psychiatry (2014) Slide 7 Who turns to heroin? Less than 4% of those who abuse prescription opioid pills will begin abusing heroin within 5 years of the onset of their pill use. 1 Pill abusers Pill abusers who begin abusing heroin within 5 years of pill addiction onset Slide 8 Drug Overdose Deaths year comparison Overdose deaths, all drugs 1999: <17, : >52,000 Opioid painkiller deaths on the rise 1999: 6, : 17,500 *PEAK* 2013: 16, : 17,500 *PEAK* Heroin deaths on the rise since abusedeterrent Oxycontin released in : 2, : 13,000 SOURCE: Vox, How the opioid epidemic became the worst drug crisis ever, in 15 maps and charts (Mar. 29, 2017). Synthetic opioids (ie: fentanyl, tramadol) on the rise 1999: : 9,600 Slide 9 Pill Crisis or Pain Crisis? 43% of adults report suffering from a MSK pain condition like arthritis, rheumatism, chronic back/neck pain, migraines % of adults report having daily pain % of adults were prescribed long-term opioid therapy (2005 survey) % of adults engaged in illicit use of prescription pain relievers last year (2013 survey) % of adults who had a major depressive episode in the previous year have abused illicit drugs. 2.1% of those who didn t have a MDE last year have abused illegal drugs ,900,000 opioid prescriptions dispensed in % increase in opioid pill prescribing from (1) Deborah Dowell et al., CDC, CDC Guideline for Prescribing Opioids for Chronic Pain United States, 2016, 65(1) Recc. & Reports 1 (Mar. 18, 2016) (of note, this study did not evaluate the duration of symptoms, so this could include chronic and acute symptoms). (2) Substance Abuse and Mental Health Services Administration (SAMHSA), Nonmedical Use of Prescription Pain Relievers Varies by Race and Ethnicity, The CBHSQ Report (June 26, 2015). (3) Laxmaiah Manchikanti et al, Opioid Epidemic in the United States, 15 Pain Physician J. ES9 (2012). (4) Sarah G. Mars et al., Ever Never I Ever Said Came True : Transitions from opioid pills to heroin injecting, 25(2) Int. J. Drug Policy 257 (Mar. 2014).

4 Slide 10 WHAT THE LAW SAYS ABOUT THE EPIDEMIC. Slide 11 Whose responsibility is it to stop the epidemic? Physical Therapist Emergency Room First Responders Doctor Municipal / Local Laws Pharmacist Policing Priorities CDC Big Pharma Federal Law Professional Regulators Criminal Courts State Law Prosecution Patient Decisions Slide 12 Emergency Room Physical Therapist Your legal responsibility First CDC Responders Professional Doctor Big Pharma Regulators Municipal / Federal Law Local Laws Policing Criminal Pharmacist Priorities Courts State Law Prosecution Patient Decisions

5 Slide 13 Privacy Laws Slide 14 Lobby for change: letters, s, phone calls What might improve access to PT + decrease addiction: Direct access to PT Get involved in drug court Lobby for Law Enforcement Assisted Diversion programs Lobby for change CITATION: Chasing Heroin, FRONTLINE. Slide 15 BREAK

6 Slide 16 ETHICS Slide 17 Trust The relationship between a PT and a patient is one of the most intense among health care disciplines. APTA Ethics + Judicial Committee (EJC) Opinion CITATION: Jason Bellamy, APTA, EJC Opinion: Aug. 3, 2001, Sexual Relationships with Patients/Former Patients. Slide 18 You have an ethical duty to: Provide compassionate + caring PT that incorporates the individuality of your patients Collaborate with patients to empower them in their healthcare decisions Refer to other healthcare providers when necessary Educate the public about the benefits of PT CITATIONS: APTA Code of Ethics, Principle 2A. APTA Code of Ethics, Principle 2D. APTA Code of Ethics, Principle 3C APTA Code of Ethics, Principle 8D Illinois Administrative Code, Title 68, Ch. VII(b), Part 1340 (incorporating APTA code of ethics into IL Admin. Code).

7 Slide 19 THE 5 TH VITAL SIGN CITATIONS: Laxmaiah Manchikanti et al, Opioid Epidemic in the United States, 15 Pain Physician J. ES9 (2012). David W. Baker, Joint Commission, Joint Commission Statement on Pain Management (Apr. 18, 2016). Slide 20 Measure + monitor the 5 th vital sign Educate providers and patients Respect the patient s right to pain management Assess the patient, consulting with others if needed Manage the pain, creating a plan with the patient Reassure the patient. Because pain is &%$#ing scary. CITATIONS: Laxmaiah Manchikanti et al, Opioid Epidemic in the United States, 15 Pain Physician J. ES9 (2012). APTA, Fighting America s Opioid Epidemic: Providing Safe Solutions for Pain (undated). Slide 21 Whose measurement counts? CITATIONS: Laxmaiah Manchikanti et al, Opioid Epidemic in the United States, 15 Pain Physician J. ES9 (2012). APTA, Fighting America s Opioid Epidemic: Providing Safe Solutions for Pain (undated). Pat Anson, AMA Drops Pain as Vital Sign, Pain News Network (June 16, 2016). Steven Ross Johnson, AMA seeks move toward opioid alternatives, Modern Healthcare (June 15, 2016). National Pharmaceutical Council, Assessment of Pain, Pain: Current Understanding of Assessment, Management, and Treatments 21.

8 Slide 22 Making assumptions about patient values A PT shall respect the patient s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal. CITATION: APTA Guide for Professional Conduct, Principle 2C Interpretation Slide 23 RELATIONSHIP-CENTERED HEALTHCARE Slide 24

9 Slide 25 Slide 26 Relationships heal. Your bond with your patient can help reduce addiction risk. (How cool is that?) CITATION: Johann Hari, TED (July 9, 2015). Slide 27

10 Slide 28 Educate your patient about the why behind their experience of pain. How did a physio help me understand why I was in pain? It turns out that I had a really nasty thought virus! And she was the first provider to realize that. [Psssst: Do you screen for those?] CITATION: Lorimer Mosely & David Butler, Explain Pain. Slide 29 Teaching Health I hurt. I m scared. I m weak. I m sick. But I m safe. Wow, I did it. CITATIONS: Eric Newhouse, VA Says 68,000 Vets Addicted to Opioid Painkillers, Psychology Today (Jan. 23, 2017). Jeremy Gauntlett-Gilbert & Sarah Wilson, Veterans and chronic pain, 7(2) Journal of Pain 79 (May 2013). K.N. Alschuler & JD Otis, Coping strategies and beliefs about pain in veterans with comorbid chronic pain and significant levels of posttraumatic stress disorder symptoms, 16(2) Eur. J. Pain 312 (Feb. 2012). George Jay Unick et al., Intertwined Epidemics: National Demographic Trends in Hospitalizations for Heroin- and Opioid-Related Overdoses, , 8(2) PLoS One (Feb. 6, 2013). Slide 30

11 Slide 31 Mental Health Partnerships Slide 32 Drug Diversions Providers diverting prescription opioids for illicit use. PTs shall discourage misconduct by health care professionals and report illegal or unethical acts to the relevant authority, when appropriate. ~ APTA Code of Ethics, Principle #4C Employee of the Month, or Drug Diverter? Wants to help with disposing of waste Hangs around after their services/shifts are complete Volunteers to help everyone Unnecessarily touches syringes for procedures In areas of facility they shouldn t be Comes in on days off or takes extra shifts Slide 39 #PTtransforms

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