Dear Colleagues,

As you are well aware, a deadly opioid epidemic has engulfed our state and the country as a whole. According to the CDC, from 2000 to 2015 more than 500,000 people died from drug overdoses, and since 1999 the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. Ninety-one Americans die every day from an opioid overdose.  This overwhelming death toll has been compared to the early days of the AIDS epidemic, a devastating period that many of us witnessed firsthand.

Our profession is uniquely positioned to proactively confront this grim reality. I am writing to share information about the current state of the opioid crisis and potential solutions, but I also want to ask for your help and inform you of what the FMA is doing.

A number of factors led to the current crisis. Aggressive advertising and assurances from pharmaceutical companies that patients would not become addicted to prescription opioid pain relievers led healthcare providers to prescribe them at greater rates. The mandated use of patient satisfaction surveys put financial pressure on hospitals and physicians to ensure that patients were satisfied with the pain control measures they received.  Evidence suggests that about 80 percent of people who use heroin first misused prescription opioids. Anecdotal reports point to sports injuries and wisdom tooth removal as prevalent points of entry for opioid addiction.

Governor Rick Scott has announced a three-pronged plan to combat this crisis.  It includes placing a restriction on the number of days for which prescriptions can be written, requiring providers who prescribe opioids to check the PDMP, and additional CME requirements. In addition, the Governor has called for an additional $50 million in funding for substance abuse treatment, mental health services, and law enforcement efforts.  Within the past two weeks, Senator Lizbeth Benacquisto and Representative Jim Boyd filed bills in their respective chambers reflecting the Governor's recommendations. The FMA staff has been actively engaged with the Governor, Senator Benacquisto, and Representative Boyd on this important issue.

The FMA is also putting together an Opioid Resource Center on our website. These resources will help all physicians better understand and respond to the opioid epidemic. We will be holding more educational events such as the highly successful FMA Opioid Summit that took place on October 6 in Tampa.

The opioid epidemic is a very complex problem. Our society must get to the bottom of the increase in addiction in general, as prescriptions are not the only factor. The Legislature needs to provide resources to citizens who are already addicted. For instance, where should an ER doctor send his or her patient after treating an overdose? What rehabilitation services are available, and who will pay for it? How will the public be educated about the importance of disposing unused opioids in prescriptions, and who will pay for that education? The list goes on and on.

For now, what you can do is reassess your prescribing practices, review and, if needed, revise any institutional guidelines and clinical pathways. The Doctors Company has put together an excellent primer on controlled substance prescribing (Click here). We urge you to consult this resource and the applicable practice guidelines for your specialty, and to stay tuned to the FMA website for updates. Thank you for your attention to this urgent matter.

Sincerely,

 

John N. Katopodis, M.D.

Florida Medical Association President

 

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