The AffirmHealth Blog

Protect Your Practice. Protect Your Patients.

Opioid Prescribing Guidelines, Urine Drug Testing

What's in the Cup: A Urine Drug Testing Primer

Posted by Jody Lutz and Mario Ramirez, MD on Apr 24, 2018 5:07:00 AM

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Urine drug testing (UDT) is a critical tool for patients on chronic opioid therapy.  It is also one of the most misunderstood. 

As most states have updated their opioid prescribing guidelines over the past two years, nearly every one now includes a requirement to conduct urine drug screening in certain populations. Unfortunately, many of these recommendations have been developed in isolation with variances across the level of testing to conduct, testing frequency, and guidelines required for medical necessity.

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weekend round up

Weekend Round Up: Four Legged Victims of the Opioid Epidemic, Opioid Scripts Down - Anti-Addiction Scripts up, Illinois & Virginia in the News

Posted by Jody Lutz on Apr 22, 2018 4:13:01 PM

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With opioid prescribing regulations being updated, national policy announcements, state guidelines as well as daily commentary regarding the opioid epidemic flooding news outlets, the AffirmHealth Weekend Round Up looks at the top headlines that caught our team’s eye. From controlled substance protocols to research focusing on pain management, addiction medicine, the ER and more provided to you in an easy to access summary. News you can use. Welcome to the Weekend Round Up.

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Chronic Pain Guidelines, opioid prescribing, prescribing protocols

CMS Announces New Guidelines on High-Dose Opioids

Posted by Jody Lutz on Apr 16, 2018 4:45:00 PM

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This month the Center for Medicare & Medicaid Services (CMS) published new limits for high-dose opioid prescriptions for Medicare Part D users. The announcement is part of the 2019 Medicare Advantage and Part D Rate Announcement and Call Letter.

The policy also follows the CDC opioid prescribing guidelines for primary care physicians released last year. High dosage thresholds outlined include parameters for prescriptions greater than 90 MME, which state a pharmacist should consult with prescriber and document the discussion. At 200 MME, a hard cap is implemented that can only be overridden by the plan sponsor. Additional guidelines for opioid naïve patients were also included, limiting initial opioid prescriptions to no more than a 7 days’ supply for the treatment of acute pain.

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weekend round up

Weekend Round Up: NIH Launches HEAL Initiative, Missouri House Approves Bill to Fight Opioid Addiction and the Stimulant Epidemic

Posted by Jody Lutz on Apr 15, 2018 6:55:53 PM

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With opioid prescribing regulations being updated, national policy announcements, state guidelines as well as daily commentary regarding the opioid epidemic flooding news outlets, the AffirmHealth Weekend Round Up looks at the top headlines that caught our team’s eye. From controlled substance protocols to research focusing on pain management, addiction medicine, the ER and more provided to you in an easy to access summary. News you can use. Welcome to the Weekend Round Up.

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Pain Management, opioid prescribing, Pain Guidelines, pain scales

Pain Scales: From Faces to Numbers and Everywhere In Between

Posted by Mario Ramirez, MD on Apr 10, 2018 11:30:00 AM

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In Medscape’s article “Talk About Pain,” R. Morgan Griffin states, “One of the hardest things about chronic pain is that only you know how bad the pain feels. There's no blood test that can show much you're suffering. There's often no outward sign, like a bandage or a cast. There's just the pain." 'Pain is always personal,' says F. Michael Ferrante, MD, director of the UCLA Pain Management Center in Los Angeles. 'It's invisible to other people looking at you -- and that can lead to a lot mistrust and difficulties in relationships.'"

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weekend round up

Weekend Round Up

Posted by Jody Lutz on Apr 8, 2018 11:47:12 AM

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With opioid prescribing regulations being updated, national policy announcements, state guidelines as well as daily commentary regarding the opioid epidemic flooding news outlets, the AffirmHealth Weekend Round Up looks at the top headlines that caught our team’s eye. From controlled substance protocols to research focusing on pain management, addiction medicine, the ER and more provided to you in an easy to access summary. News you can use. Welcome to the Weekend Round Up.

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Opioid Prescribing Guidelines, opioid prescribing, risk assessment

Are You Effectively Assessing Risk When Prescribing Opioids?

Posted by John Cole on Apr 3, 2018 5:04:00 AM

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The staggering rate of prescription opioid misuse, abuse, and overdose has placed a heavy burden on prescribing clinicians and their practices. Federal and state regulators have responded by enacting extensive opioid prescribing guidelines. Across the board, these guidelines prioritize the importance of properly assessing a patient’s risk of misuse or abuse.

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weekend round up

Weekend Round Up

Posted by Jody Lutz on Mar 31, 2018 3:30:00 PM

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With opioid prescribing regulations being updated, national policy announcements, state guidelines as well as daily commentary regarding the opioid epidemic flooding news outlets; the AffirmHealth Weekend Round Up looks at the top headlines that caught our team’s eye. From controlled substance protocols to research focusing on pain management, addiction medicine, the ER and more...provided to you in an easy to access summary. News you can use. Welcome to the Weekend Round Up.

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weekend round up

Weekend Round Up

Posted by Jody Lutz on Mar 25, 2018 5:03:00 PM

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Some of the news stories that caught our eye at AffirmHealth for the week of March 18th:

CLINICAL NEWS

March 19, 2018

Bedside Quantitative Sensory Testing May Reliably Assess Sensory Profiles in Neuropathic Pain

Clinical Pain Advisor

AffirmHealth Key Take Away: The investigators suggest that the development of a “standardized, validated, easy-to-administer, bedside sensory testing battery that could be used in a variety of settings to assess patients' sensory profiles” may be helpful for patients with neuropathic pain.

According to study coordinator Alexandra Buliteanu, of the Brigham and Women's Hospital at Harvard Medical School in Boston, Massachusetts, “The availability of validated bedside QST that uses inexpensive, easily handled, and portable equipment may facilitate research to a wider variety of patient population and therefore progress research in chronic neuropathic pain.”

Find the full article here: Neuropathic Pain Sensory Profiles Assessment With Bedside Quantitative Sensory Testing

IT NEWS

March 19, 2018

Why Process Is U.S. Health Care’s Biggest Problem

Harvard Business Review

AffirmHealth Key Take Away: Health care technology is very effective when it is used to support a well-designed care process. The design of new standard care processes need to be owned and driven by the people doing the work, not by some outside consulting firm that brings a 100-page playbook as the answer. As the frontline workers create new designs, they need certain systems that can help them deliver the improved care. Examples of these systems include electronic alerts for medication interactions and reminders to ensure all steps in the care process for the pneumonia patient are followed.

Find the full article here: Why Process is U.S. Health Care's Biggest Problem

NATIONAL NEWS

Holding Drugmakers Accountable for the Opioid Crisis

March 18, 2018

ABCNews

AffirmHealth Key Take Away: Hundreds of communities in the U.S. are suing the makers and distributors of opioid painkillers, arguing that the companies should help pay the enormous costs of the deadliest drug epidemic in U.S. history. Since 2000, more than 340,000 Americans have died from overdoses of opioids, which include prescription painkillers and illegal drugs like heroin. The financial toll has been estimated at $500 billion in 2015, according to the latest White House figures, which include deaths, health care, lost productivity and criminal justice costs. But can the drug industry be legally compelled to help pay for the damage?Rebecca Haffajee, a lawyer and professor of public health at the University of Michigan, answered questions about past cases against opioid drugmakers and the latest lawsuits.

Find the full article here: Q & A: Holding Drugmakers For The Accountable Opioid Crisis

HEALTH & SCIENCE

States: Federal Money For Opioid Crisis A Small Step Forward

March 25, 2018

The Washington Post

AffirmHealth Key Take Aways: The federal government will spend a record $4.6 billion this year to fight the nation’s deepening opioid crisis, which killed 42,000 Americans in 2016. But some advocates say the funding included in the spending plan the president signed Friday is not nearly enough to establish the kind of treatment system needed to reverse the crisis. A White House report last fall put the cost to the country of the overdose epidemic at more than $500 billion a year. Former U.S. Rep. Patrick Kennedy, a Democrat who served on President Donald Trump’s opioid commission last year, said there are clear solutions but that Congress needs to devote more money to them.

Find the full story here: States: Federal Money For Opioid Crisis A Small Step Forward

LEGISLATIVE OVERVIEW

The Overdoes Prevention and Patient Safety7 Act: What’s The Story?

March 24, 2018

American Council on Science and Health

AffirmHealth Key Take Aways: In 1975 Congress became concerned about the confidentiality of patient records concerning alcohol and drug abuse and instituted regulatory safeguards. Congress’s initial legislation, the Public Health Service Act, attempted to ensure that a patient receiving treatment for a substance use disorder is not made more vulnerable than an individual with a substance use disorder who does not seek treatment; by separating substance abuse records from our health records; and requiring a separate written consent from the patient to access them. While the regulation has been amended over time (most extensively in 1987) to enhance confidentiality, the use of electronic medical records, the increasing use of performance metrics and the pressing need for coordinated care made the current safeguards a barrier in providing care for patients and guiding policy.

H.R. 3545, the Overdose Prevention and Patient Safety Act amends these regulations and is being considered by the House Energy and Commerce Subcommittee on Health. The changes proposed clarify the definitions used in the current protections, alter the written consent process and further extend the protection of patient confidentiality in criminal proceedings.

Find the full article here: Overdose Prevention And Patient Safety Act: What’s The Story?

NATIONAL NEWS

Opioid Painkiller Is Top Prescription in 11 States

March 22, 2018

U.S. News & World Report

AffirmHealth Key Take Aways: Though opioid prescriptions appear to be on the decline, Vicodin and Norco remain popular, especially in the South. In Tennessee, however, Suboxone, a medication used to treat opioid addiction, is even more popular. Oddly, Adderall and generic versions of the medicine for attention deficit and hyperactivity disorder are the most prescribed drugs in South Carolina.

Find the full article here: Opioid Painkiller Is Top Prescription In 11 States

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Opioid Epidemic, regulations

Trump Announces Strategy to Combat Opioid Epidemic

Posted by Mario Ramirez, MD on Mar 20, 2018 5:05:00 AM

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This afternoon in New Hampshire, a state hit particularly hard by the opioid epidemic, President Trump announced a three part strategy to combat the worsening crisis.  Opinions about the approach have been mixed with some calling it a return to "a comprehensive drug policy," while others are concerned that a heavy focus on punitive measures will limit efficacy.  Here's our summary:

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