An Open Letter to Philadelphia Physicians on the Overdose Epidemic From the Philadelphia County Medical Society

Dear Fellow Physicians:

We have presented two extensive articles in this issue of Philadelphia Medicine, on the overdose epidemic in our city. In the spirit of those articles, we are urging you to do your part to help save lives from overdoses by making yourself familiar with the naloxone protocol we are making available.

Pennsylvania, like the rest of the nation, is currently suffering the worst overdose epidemic in history. Philadelphia is, unfortunately, working its way towards leading the nation in fatal overdoses — from 493 in 2013, to 655 in 2014 — a 33% increase. Preliminary data shows that 2015 is even higher.

To help combat this terrible loss of life and help save the lives of Pennsylvania’s most vulnerable, the General Assembly enacted Act 139, which became effective Nov. 29, 2014. This legislation, along with a standing order authorized in October of 2015, allows people to obtain and administer the antidote medication, naloxone – a medication that can reverse an overdose caused by an opioid drug, such as prescription pain medication or heroin. The standing order is intended to ensure that residents of the Commonwealth who are at risk of an overdose, or who are family members, friends or other persons who are in a position to assist a person at risk, are able to obtain naloxone.

The standing order addresses the biggest barrier to responding to the overdose crisis — lack of access to life saving medication — by more explicitly encouraging health care professionals to prescribe naloxone to eligible persons.

The standing order may be used by eligible persons in lieu of a prescription, and expands the definition of those eligible for naloxone prescribing. This order also serves as authorization for pharmacists to dispense naloxone and devices for its administration in certain forms.

Medical providers, however, are best suited to prescribe naloxone to their patients who are at risk of opioid-related overdoses. Eligible persons include people who voluntarily request naloxone, or who are at risk of overdose, including those who are:

–       taking prescription pain relievers (i.e., Vicodin, Percocet, oxycodone) for more than three months;

–       taking methadone or burprenorphine (Suboxone) for the treatment of opioid use disorder;

–       having concurrent prescriptions for opioids and benzodiazepines;

–       having experienced a previous non-fatal opioid overdose;

–       any individual who is at risk of experiencing an opioid-related overdose;

–       any family member, friend or other person who may assist an individual at risk for an opioid overdose.

As those best positioned to screen for overdose risk and address it, medical providers are uniquely positioned to help reduce overdose deaths. They can do this by assessing their opioid prescribing practices, with attention to duration and concurrent prescriptions, and actively prescribing naloxone HCl (Narcan, naloxone HCl or other generic equivalents) to at-risk patients or their friends and family members, and educating them on the proper use of these products.

We understand that this new legislation may be confusing in terms of what is permissible and how prescriptions should be written. For this reason, we have written a naloxone dispensing protocol for prescribers to understand the proper administration of intranasal and intramuscular naloxone HCl.

You can view the protocol below. If you are having trouble viewing the protocol, or would like more information, please contact Robert Miyamoto at (215) 563-5343 x 102 or send an e-mail to [email protected].

Please help us address this health epidemic and significantly reduce unnecessary deaths from fatal opioid overdose.

Sincerely,

Michael A. DellaVecchia, MD, PhD, FAC, FICS

154th President

 

Priya E. Mammen, MD, MPH

PCMS Public Health Committee

 PrescribingProtocol

MCONaloxoneCoverageGrid

 

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