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Expert Says N.H. Opioid Prescribing Rules Are On Track, But Adds Some Cautionary Notes

Charles Willams

Heroin pills. That’s how Andrew Kolodny describes oxycodone, one of the most widely prescribed – and abused – narcotic painkillers in the U.S. 

Kolodny is executive director of Physicians for Responsible Opioid Prescribing and senior scientist at the Heller School for Social Policy and Management at Brandeis University. He joined The Exchange this week to discuss the opioid crisis – its origins and how states, including New Hampshire, are trying to overcome it.

Kolodny said New Hampshire, where more than 400 people died of drug overdose in 2015, is on the right path for tackling the problem, even if a bit late to the effort; it was the 49th state to adopt a prescription drug monitoring program and only recently has moved toward making it mandatory.

These programs, especially if mandatory, can help cut down on abuse of prescription painkillers, he said.

A bill now advancing in the state legislature requires various boards to adopt rules for prescribing opioids. Rep. Cindy Rosenwald, Democrat from Nashua, is the lead sponsor.

In a three month period alone, 13 million doses of the strongest type of opioids were prescribed in New Hampshire, Rosenwald said.  “That’s ten doses for every person in this state.”

Rosenwald said her bill was crafted with input from the NH Medical Society and the NH Board of Medicine, which recently adopted new rules for prescribing the drugs.

Kolodny, who tracks these efforts nationally, agreed with much of what New Hampshire is attempting to do. But he issued one cautionary note about a screening requirement to help medical providers determine whether a patient is at risk of becoming addicted. 

What concerns him is the idea that patients can be screened to figure out who is at low, medium, or high risk for having a problem with opioids. Among substances that are prone to abuse, opioids are in a category by themselves, he said.

“I guess the idea would be that if a patient doesn’t have any personal or family history of a drug or an alcohol problem or mental health history, that we don’t have to worry so much about those patients,” he said. “And it is true that some patients can be at higher risk for getting into trouble, but there really is no such thing as low risk.”

Also during the program, Dr. David Strang, an emergency physician and chairman of the New Hampshire Prescription Drug Monitoring Program Advisory Council, said the state Board of Medicine should strengthen some rules. For instance, he said emergency room physicians and others who treat acute pain should be required to use the prescription drug monitoring program. 

He said Rosenwald’s bill closes that so-called “acute pain” gap.

One caller raised concerns that the new rules will make it difficult for those with legitimate need for the painkillers to obtain the drugs. But Dr. Gil Fanciullo, director of the Pain Management Center at Dartmouth-Hitchcock Medical Center, said that the board’s new rules should not interfere with such cases.  “I don’t think there’s anything in these recommendations that are onerous or inappropriate,” he said. 

Fanciullo also said he has found that some patients with chronic pain benefit from long-term use of opioids, while acknowledging that this has become a controversial point of view.

If Rosenwald’s bill passes in the Senate and is signed into law by Gov. Maggie Hassan, all of the state’s medical licensing boards will be required to have their rules in place by September 1. 

The full conversation about prescribing opioids during an addiction crisis can be found here.

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