In the ongoing fight against the abuse of opioids, the University of Arkansas for Medical Sciences has launched a free weekly education and consultation service for Arkansas health-care providers, Governor Asa Hutchinson announced at a press conference today.

The AR-IMPACT (Arkansas Improving Multidisciplinary Pain Care Treatment) partnership includes the UAMS, the Office of the State Drug Director, the Arkansas Department of Health, the Arkansas Departm

ent of Human Services, the Arkansas State Medical Board, Blue Cross-Blue Shield, the Arkansas Medical Society and the Arkansas Academy of Family Physicians.

“This education portal for doctors is an important new weapon in the fight against this terrible epidemic that is killing hundreds of Arkansans every year,” Governor Hutchinson said. “It is not an exaggeration to call this epidemic one of our state’s greatest challenges. Today we understand more about opioid drugs than we did a decade ago. With that advanced knowledge, we must utilize every tool possible to pass along this information to doctors so that we can save lives and spare more patients the tragedy of addiction.”

AR-IMPACT will provide weekly seminars at noon on Wednesdays that feature specialists in the treatment of pain and addiction, a physical therapist, a psychologist, and pharmacists who are trained in opioid-related issues. After the presentation, doctors may join via teleconference to discuss cases for individualized feedback about approaches to treatment.

The 16 professionals in the opioid-epidemic crisis who joined the governor at the press conference at the state capitol included UAMS Interim Chancellor Stephanie Gardner, who accepted a $104,000 check from Blue-Cross-Blue Shield.

“We are thankful to Arkansas Blue Cross and Blue Shield for their partnership as we work to improve pain management in Arkansas through UAMS AR-IMPACT,” Chancellor Gardner said. “As the state’s only health sciences university, UAMS is uniquely positioned to address this issue head on for the betterment of all Arkansans.”

Curtis Barnett, president and CEO of Arkansas Blue Cross, presented the check.

“Arkansas Blue Cross recognizes that the opioid epidemic threatens the health of the people of Arkansas in many ways,” President Barnett said. “For those in chronic pain and for those treating them, there is no easy solution. We already have been working with health-care providers to help get a better understanding of opioid prescribing patterns in Arkansas. We believe the new AR-IMPACT education program with UAMS will help doctors learn about resources and alternatives to managing pain. It will take everyone working together to truly impact this crisis.”

Kirk Lane, Director of the State Drug Office, said the epidemic is a priority.

“As drug director, I’ve talked with so many families who have been impacted, and it is clear that this crisis respects no class, race or income boundaries,” Director Lane said. “It is evident that a collaborative approach is necessary to change the direction of this epidemic. We will make that difference with education and the willingness to change.”

Those who wish to utilize the AR-IMPACT portal must register at www.arimpact.uams.edu.

“I feel that if an officer has Narcan, then they should only use it on children, officers and other significant situations that are not your average overdose,” Lonoke Co. Dispatcher.

Arkansas Democrat-Gazette(15 Apr 2018 by Amanda Claire Curcio) 

Makers of narcotic painkillers gave millions of dollars to Arkansas doctors between 2013 and 2016. At least 800 state residents died from opioid overdoses during the same period. Federal data reveal that opioid manufacturers directed $5 million in “general payments” to about three-quarters of the state’s doctors for consulting, meals, travel and promotional speaking.

A smaller group — 1,600 physicians — received a total of nearly $689,000 specifically to promote opioid products during the four-year period, an analysis of federal data by the Arkansas Democrat-Gazette shows. Taking money from drug companies doesn’t mean a doctor has done anything wrong, yet recent studies assert that these types of payments, even when under $50, affect how physicians prescribe. Some doctors, health experts and officials interviewed by the newspaper said that accepting money from pharmaceutical companies presents a conflict of interest for physicians.

“So many doctors are more merchants than they are physicians now,” said Dr. Janet Cathey, an assistant professor at the University of Arkansas for Medical Sciences. “How do doctors get away with it? Your ethical, legitimate doctors won’t do this.”

She described some doctors as complicit in the deluge of powerful prescription narcotics in the state, where there were 79 opioid pills for every one of Arkansas’ nearly 3 million residents in 2016, according to county-level health records. Cathey acknowledged that most of the state’s nearly 6,100 doctors accept payments from drug companies to promote various medications, not just opioids, but she says that taking money from opioid-makers is especially problematic considering how many Arkansans are affected by the opioid epidemic.

Last year, New Jersey and California capped promotional payments to doctors; Maine banned such contributions. Other health professionals say doctors aren’t so easily influenced.

“Doctors are well aware of the intentions behind the pharmaceutical industry. There is a difference between doctors getting bribes and doctors who believe in a product,” said Dr. Marvin Covey, a recently retired pain management specialist and former medical director of Pain Treatment Centers of America, which has eight offices in Arkansas.

“It is a slippery slope, however,” Covey added. “Doctors need to be very careful.”

Some policymakers say doctors shouldn’t bear all the blame for the opioid epidemic that has surged across the United States for at least a decade. Drug companies took advantage of a change in the guidelines the medical community uses to treat patients with chronic pain, said Dr. Joseph Thompson, president of the Arkansas Center for Health Improvement.

“But I can’t say that’s the only cause of the epidemic,” he said.

Doctors lacked clear guidance on how to best prescribe opioids, and there was a lack of education about the associated risks, the health policy center leader said.

“With the development of increasingly strong drugs, the potential for dependency and addiction went up,” he added.

Taking opioids activates certain brain receptors, and after repeated exposure to the drug, pain patients need opioids just to feel normal, Thompson explained. Pharmacists and drug distributors also bear some responsibility for fueling the state’s opioid epidemic, a recently filed lawsuit against the opioid industry alleges.

INFLUENCING DOCTORS

Doctors who took the most money from opioid-makers practiced medicine in counties with the highest opioid prescribing rates.

For instance, Sebastian, Craighead and Independence counties’ physicians received more payments from opioid-makers, when adjusted for population, than all counties but one, according to the newspaper’s analysis of 2016 federal data.

The number of opioid prescriptions in those counties ranged from 157 to 169 for every 100 residents, data from the federal Centers for Disease and Prevention Control show. The state average prescription rate in 2016 was 115 per 100 residents; the U.S. rate that year was 66 per 100.

Information about what drug companies pay doctors comes from the newspaper’s analysis of Open Payments, a data resource compiled by the CDC.

Doctors don’t get money only for promoting opioids, the payments database shows. The same firms that make pain pills also produce non-narcotic medications and pay doctors for promotional activities related to those drugs.

Opioid-makers also paid more than $58 million to physicians to conduct research between 2013 and 2016. Only $8,000 in research payments went to opioid-specific projects.

Studies and national news reporting reveal that incentives to doctors from drug companies affect how they prescribe.

Analysis by Harvard University researchers and cable news channel CNN, released last month, found that doctors who write the most opioid prescriptions often receive the most general payments from opioid manufacturers.

Doctors whose opioid prescription volume ranked among the top 5 percent received twice as much money from opioid manufacturers as compared with doctors whose prescription volume fell in the middle, the researchers found. Doctors in the top 1 percent usually received four times as much as a typical doctor.

The Harvard researchers looked at records of almost 400,000 doctors who wrote opioid prescriptions to Medicare patients between 2014 and 2015. Of those physicians, 54 percent received payments from opioid-makers, they found. The study analyzed both the Open Payments database and another federal database that tracks Medicare prescriptions that doctors write.

A 2017 University of North Carolina at Chapel Hill report also found that doctors were between 29 percent and 78 percent more likely to prescribe a drug promoted by a pharmaceutical company. A 2015 study, published last year in the Journal of the American Medical Association, yielded similar results when looking at different medications.

PAIN PRACTICES

The emergence of OxyContin, Purdue Pharma’s brand-name oxycodone, and a subsequent flood of other narcotic pain pills prompted an “explosion” in the pain management profession, according to UAMS professor Cathey.

“It became just so lucrative to be a pain doctor,” she said.

To Cathey, the issue of over-prescribing became apparent when a car crash left her paralyzed and doctors told her to take an excessive amount of medication to treat the resulting chronic nerve pain.

“We’ve become such a pill-oriented society,” she said. “So of course patients think it’s normal to take all these drugs.”

Within a few years of OxyContin’s 1996 debut, drug companies’ direct marketing to doctors jumped tremendously.

The number of times drug company representatives met with doctors rose from an average of four or five times a month through the 1990s to up to 16 visits a month by early 2004, according to a study in the Journal of the American Medical Association and a survey in the New England Journal of Medicine.

Almost 100,000 drug industry representatives tried to influence almost 700,000 physicians at that time, federal Health Resources and Services Administration data show.

Collaboration between an influential hospital accreditor and the opioid industry in 2001 changed how doctors treated pain, further contributing to the rising epidemic, Cathey said.

The Joint Commission, a nonprofit certifying 99 percent of all U.S. health care organizations, including in Arkansas, released new guidelines that counted pain as the fifth vital sign, alongside pulse rate, body temperature, respiration rate and blood pressure.

These “Pain Management Standards” encouraged increased treatment of pain, including heavier use of medication. Essentially, under the standards, a compassionate doctor must try to alleviate the patient’s pain; the simplest way to do so was to prescribe a pain pill.

That same year, the Joint Commission collaborated with the National Pharmaceutical Council, made up of several opioid manufacturers and distributors, to publish a report saying that pain was undertreated and that there were “adverse consequences of inadequately managed pain.”

The basis for the commission’s standards is often attributed to a 1996 article in the New England Journal of Medicine, titled “Assessment of Patients’ Pain.” The article cites a study that says doctors and nurses too often discounted patients’ perceptions of their own pain. The majority of patients surveyed for the study had cancer or chronic diseases like sickle cell anemia or AIDS.

Another 2001 Joint Commission report said that doctors had “inaccurate and exaggerated concerns about addiction, tolerance and risk of death.”

Dr. David Baker, the commission’s executive vice president, says the 2001 standards should not be blamed for the opioid epidemic. At the time, doctors failed to address pain, which was a “national and international public health problem,” Baker said.

“We needed to have other ways for organizations to improve pain control,” he said. “That was an important shift away from the individual physicians and really to the organizations and systems of care.”

PROMOTING PILLS

Two lawsuits filed in separate Arkansas courts last month say the shift in how the medical profession viewed pain and its treatment helped push more pain pills into the hands of patients.

The suits also accuse the drug companies of taking advantage of primary care physicians who might not be well-trained in managing pain.

Both suits allege that certain drug companies unleashed the opioid crisis in Arkansas in part by compensating doctors to promote the use of addictive opioids to colleagues.

The paid doctors were part of the drug makers’ “speaker bureaus” that promoted particular drugs during forums attended by other doctors, according to the suits.

“These speakers give the false impression that they are providing unbiased and medically accurate presentations when they are, in fact, presenting a script prepared by manufacturer(s),” both suits say.

The speaker programs were one part of a marketing scheme designed to convince doctors and patients that opioids can cure chronic pain, without revealing the probability of addiction and related long-term side effects, the suits claim.

Arkansas Attorney General Leslie Rutledge filed the state’s suit in Pulaski County Circuit Court on March 29. The complaint targets three companies — Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson — which she said manufacture the most-used opioids in Arkansas.

A coalition of 87 Arkansas counties and cities filed a lawsuit in Crittenden County Circuit Court on March 19 against 52 opioid manufacturers, including Purdue, Endo Pharmaceuticals and Johnson & Johnson. That effort is led by the Association of Arkansas Counties and the Arkansas Municipal League.

Both pharmacists and the opioid distributors who let those pharmacists order large quantities of opioids unchecked also contributed to the health problem, the coalition-led suit asserts.

The suit named pharmacist Christopher Watson, who was sentenced to 10 years in federal prison for conspiracy to unlawfully distribute pain pills last year. FBI agents found that Watson sold tens of thousands of hydrocodone and oxycodone pills after-hours from Perry County Food and Drug, a retail pharmacy owned by Watson’s father.

The two lawsuits seek punitive monetary damages. The state’s suit also seeks an injunction to stop what it calls deceptive marketing practices.

Opioid-makers named in the suits haven’t responded to the newspaper’s repeated requests for interviews.

Arkansas doctors receive fewer contributions from drug companies now than they did in the past, said Thompson, the Arkansas Health Improvement Center executive.

Physicians are barred from having certain types of meetings with drug representatives and must disclose conflicts of interest, he said.

Thompson said legislators and regulators “need to intentionally and explicitly create policies” requiring doctors to disclose to the Arkansas State Medical Board when they receive significant contributions from drug companies.

“There have been steps to restrict the pharmaceutical and medical device companies to influence a doctor’s prescribing patterns,” he said. “It’s a lot better than it used to be.”

The Open Payments database, which shows contributions drug companies made to individual doctors, was required by the 2010 Physician Payments Sunshine Act, enacted the same year as the Patient Protection and Affordable Care Act. Public records of such payments before 2013 aren’t available.

Doctors aren’t required to tell patients what payments they receive from drug companies.

The highest-paid Arkansas doctor in the federal database, Dr. Mahmood Ahmad, received more than $156,000 from opioid-makers between 2013 and 2015.

For years, the Arkansas State Medical Board investigated Ahmad for over-prescribing controlled substances, and in 2016, board members voted to revoke his license. That revocation has since been upheld by the Arkansas Court of Appeals.

During the disciplinary hearing, board attorney Kevin O’Dwyer called out Ahmad’s “routine reliance” on starting patients with high doses of opioids, improper patient record-keeping, gross negligence and “professional incompetence.”

O’Dwyer also cited allegations against the doctor in Alaska, where he had already surrendered his license to practice after regulators found that he had prescribed life-threatening amounts of controlled substances to patients in Anchorage.

Last year, one of Ahmad’s former patients, Cheryl Hartsfield, sued Ahmad and others in Pulaski County Circuit Court. The case is pending.

The suit says that Arizona-based Insys Therapeutics Inc. targeted Ahmad to bump up sales of Subsys, a spray made of fentanyl, an opioid 50 to 100 times stronger than morphine.

Corporate emails show that Insys was aware of Ahmad’s excessive prescribing, yet the company still paid the Sherwood doctor “speaker fees” in return for prescribing the drug, the suit claims.

Between 2014 and 2015, Ahmad wrote more than 1,450 Subsys prescriptions and collected nearly $150,000 from Insys, the suit states. By comparison, Ahmad had written roughly 50 prescriptions for the opioid spray before establishing a relationship with Insys.

In response, Insys denied that its actions were “deceptive, misleading, false or otherwise unconscionable,” according to court documents.

Ahmad now lives in Islamabad, court records indicate.

Medical board records don’t show any reported licensing problems for other top-paid Arkansas doctors in the Open Payments database.

UAMS bioethics professor Micah Hester says it’s important for doctors to be involved with the development of medicines their patients will eventually use, which means doctors must interact with the pharmaceutical industry.

Conflicts of interest that arise when doctors take money from drug companies can be mitigated, he said.

Physicians should tell patients about their affiliations with drug manufacturers before prescribing, and offer patients alternative treatments, said Hester, who chairs the medical school’s Department of Medical Humanities and Bioethics.

Doctors also need to understand how receiving contributions can affect their behavior — even subconsciously, he said.

“We want intelligent decision-making by doctors, not unconscious bias doing our work,” he said. “We want to say we’re doing our best by our own determination. We want to be able to control outcomes, not just have them occur.”

LITTLE ROCK — The University of Arkansas for Medical Sciences (UAMS) is attacking the nationwide opioid epidemic on multiple fronts that have produced new research and treatment options for patients and health care providers across Arkansas and beyond.

“As the state’s only health sciences university, UAMS is uniquely positioned to address this issue head on for the betterment of all Arkansans,” said Interim Chancellor Stephanie Gardner, Pharm.D., Ed.D. “Our researchers are grounded in a scientific approach, our faculty are committed to both education and clinical care, and our influence in health care reaches throughout the state. We are summoning these resources in an effort to turn the tide on this deadly epidemic.”

There were 116 deaths per day from opioid-related drug overdoses in the United States in 2016, according to the U.S Department of Health and Human Services. Arkansas ranks second in the nation for its opioid prescribing rate with an average of 114.6 prescriptions per 100 people, according to U.S. Centers for Disease Control and Prevention data from 2014-2016.

Research to improve understanding of opioid addiction and its treatment is ongoing in departments across campus, and some of it is having national impact.

For example, the Centers for Disease Control Prevention Morbidity and Mortality Weekly Report published a study in 2017 led by UAMS pharmacy professor Bradley Martin, Pharm.D., Ph.D., that showed that by prescribing patients opioid supplies of three days or less, providers can reduce the likelihood of the patient using opioids chronically one to three years later.

The UAMS Psychiatric Research Institute’s Division of Health Services Research, directed by Teresa Hudson, Pharm.D., Ph.D., is conducting a variety of studies related to opioid addiction, including opioid addiction among people with mental health diagnoses and among veterans.

One study found that people with mental health and substance abuse diagnoses receiving therapy and regular doctor checkups were less likely to die, but only if they were not prescribed opioids or benzodiazepines. Another study showed that veterans from Iraq and Afghanistan were prescribed opioids at rates similar to the rest of the U.S. population, indicating that overprescribing is a nationwide issue not specific to veterans. Three related studies are looking at methods to decrease opioid use and improve pain management among veterans with chronic pain.

Peter Crooks, Ph.D., is working to develop safer opioid molecules that work better for pain than existing drugs, with fewer side effects and less potential for addiction. Within the Women’s Mental Health Program, Jessica L. Coker, M.D., is studying opioid addiction in pregnant women. Lisa Brents, Ph.D., is developing new therapies for opioid addiction during pregnancy that reduce fetal exposure to opioids. William Fantegrossi, Ph.D., is studying new types of opioids and whether they are more addictive than older types or require more aggressive treatments for dependence and overdose. Benjamin Teeter, Ph.D., is studying ways to more effectively distribute naloxone, which is used to treat opioid overdoses in emergency situations, in the community. Bradley Martin is also about to initiate a study to see if physical therapy can interrupt long-term opioid use among patients with low back pain.

The Psychiatric Research Institute’s Center for Addiction Research has many ongoing studies related to improving opioid detoxification treatments by testing different methods and drugs or combinations of the two.

In addition to performing the kind of research that could change physician behavior nationwide, UAMS clinicians are turning a critical eye to their own behavior in the name of improvement.

UAMS is the state’s largest public employer, with a hospital, five colleges, seven institutes, a Northwest Arkansas campus, a network of regional centers statewide and physician placement partnerships with Arkansas Children’s Hospital, the VA Medical Center and Baptist Health.

With such a wide reach, changes to the institution’s internal processes can have a huge impact.

For example, colorectal surgeons in the UAMS College of Medicine Department of Surgery set out to change the way its physicians helped their patients manage pain, limiting opioid use as part of a comprehensive Enhanced Recovery Protocol. The process began with a year of internal education about the new approach and the evidence to back it up, followed by an official kickoff in 2015.

The latest data show that over a two-year period, narcotic use decreased 40 percent. Patients who are not prescribed narcotics are well enough for discharge an average of 1.5 days sooner. Complications resulting in readmission are also down among those patients.

“When we looked at the data, we saved about $2 million over two years just in length of stay alone, and if we accounted for other factors, like the reduction in complications and readmissions, we’re probably saving more,” said Jonathan A. Laryea, M.D., colorectal surgeon and associate professor of surgery. “More importantly, what’s behind those numbers is that our patients are doing better and getting better sooner. We’ve known for some time in the literature that narcotics impede recovery and increase complications, but now we have our own institutional data to show that’s true.”

Meanwhile, the Department of Orthopaedic Surgery conducted a similar internal review and developed its own opioid prescription guidelines. Simon Mears, M.D., orthopaedic surgeon and professor of orthopaedic surgery, helped lead that effort. In a little more than a year, their narcotic prescriptions have decreased by a third.

Both Laryea and Mears said it’s common for patients to come to them for surgery already on high doses of opioids prescribed to them by other doctors.

“So we are working on it from both ends,” Mears said. “In orthopaedics, it’s been incredibly common in the past for people to be prescribed narcotics for things like osteoarthritis, when in fact they don’t help. There has also been evidence to show that if people are on narcotics before surgery, they actually do worse with something like a knee replacement. So communicating with patients about that has become a big part of our effort.”

With that issue in mind, the orthopaedics team enlisted the help of UAMS’ Center for Health Literacy, which produced clear and easy-to-read materials about opioids to help with doctor-patient discussions about pain management and expectations before and after surgery.

Arkansas is meeting the national average on a recently released report from the National Health Security Preparedness Index. The overall preparedness level in Arkansas stands at 7.0 for 2017, a 12.9% increase from 2013. The national average is 7.1.

“This is good news for Arkansas, but we don’t need to stop our efforts,” said Arkansas Drug Director Kirk Lane. 

Although the National Health Security Preparedness Index involves multiple factors, Lane believes the opioid epidemic plays a large role in whether states are meeting, exceeding or falling behind. He said the opioid epidemic has certainly caused some states to decline in health security, such as Ohio and West Virginia (where many experts call the epicenter of the opioid epidemic).

Arkansas is second in the nation for over-prescribing opioid medications at an average of 114.6 opioid prescriptions per 100 people (the national average is 66.5 prescriptions per 100 people), but increased emphasis in education, prevention and treatment are combating the epidemic.

“We are starting to see good numbers come in for the state,” He said. “I think our emphasis to providing first responders throughout the state with Naloxone kits is also a key component to meeting the national average. While we are saving lives with those kits – 64 lives since January 1, 2018 – we are diligent in our efforts to educate the public about not only the dangers of taking opioid medications, but also about the importance of safely storing them.”

“We are earnest in promoting the Monitor. Secure. Dispose. mantra. We encourage people to monitor their medications, secure them in a locked box, and dispose of expired or unneeded prescriptions at one of our near 200 secured drop-box locations in the state.”

One of the priorities of the treatment aspect is to erase stigma. Lane said it is important that people entering an addiction treatment facility receive support and encouragement from the community at large. Dr. John Clay Kirtley, Executive Director of the Arkansas State Board of Pharmacy, has witnessed stigma first hand.

“Many people have a very stereotypical image of what a drug addict or alcoholic looks like,” He said. “I grew up in Camden, Ark. and we had people there that fit that stereotype – the town drunk or town addict – and they were shunned by society.”

But Dr. Kirtley said he has also witnessed people have an “awaking of awareness.”

“One of the best exercises we did in pharmacy school was attending addiction meetings, but a lot of students were not happy at all that they had to go to those meetings to ‘Hang out with drug addicts,’” he said. “But once [students] went, they realized that the people in those meetings look just like them. I’ve seen that even with students in my own classes I teach today.”

“I tell my students that ‘this is an us disease, not a them disease.’ Until society buys in that this is an ‘Us’ issue and not a ‘Them’ issue, it will be very difficult to make progress.”

A key component to the prevention effort is to encourage everyone to participate in the Arkansas Prescription Drug Take Back Day, which will be held at a plethora of locations throughout the state from 10 a.m. to 2 p.m. on Saturday, April 28. All locations of event sites, as well as permanent drop-box locations, can be found by click the Collection Sites tab on ardrugtakeback.org.

The medications collected from the Arkansas Prescription Drug Take Back Day will be destroyed in an environmentally safe manner. For more information about the National Health Security Preparedness Index, visit https://nhspi.org/states/arkansas/ .

U.S. Surgeon General Dr. Jerome Adams said he was “very impressed” with the work and progress being made in Arkansas in the effort to reduce effects of the opioid epidemic. Dr. Adams spoke with representatives of several state agencies, as well as a few pharmacy students from various universities in the state, at the Arkansas State Board of Pharmacy (ASBP) Offices on Thursday.

Dr. John Clay Kirtley, Executive Director of the ASBP, unveiled to Dr. Adams a new program called “Labels Save Lives” to further disseminate educational material about the opioid epidemic. Through the innovative program, blue labels will be placed on prescription bottles at pharmacies throughout the state guiding recipients of the prescriptions to log onto ardrugtakeback.org.

“As you will see on our labels, the message is clear: Protect our children. Dispose of your meds safely,” Dr. Kirtley said. “In this campaign, we are in the process of distributing 500,000 pharmacy auxiliary labels to pharmacies throughout the state to be used this month and lead people not only to our website, but to also be a flag of recognition for the Arkansas Prescription Drug Take Back Day that is being held in coordination with the national takeback day on April 28.”

[On April 28, nearly 200 locations across Arkansas will host a site for the Arkansas Prescription Drug Take Back Day from 10 a.m. to 2 p.m. in which people are encouraged to drop off expired or unneeded prescription drugs. These medications will later be destroyed in an environmentally safe manner.]

Dr. Adams was also updated on the status of the state’s naloxone program for first responders. Arkansas Drug Director Kirk Lane was not available for the meeting, but he sent information to Dr. Adams stating that, “We have more than 3,000 naloxone kits out to first responders in Arkansas, and there have been 64 lives saved since Jan. 1, 2018 with naloxone kits.”

Dr. Kirtley also talked about working with drug rehabilitation/treatment facilities to receive naloxone kits and training on the administration to their staff. He further said that the training needs to be extended to family members once a person is released from a treatment facility, in the event that a relapse and an overdose occurs.

U.S. Surgeon General Adams was also introduced to Dr. Cheryl May, director of the Criminal Justice Institute in Little Rock, who Dr. Kirtley said has been “a critical component to our success” in providing first responders with naloxone kits and with training.

“Dr. May has taken a distinct lead on educating law enforcement about the necessity for and appropriate use of naloxone in communities,” Dr. Kirtley said. “She has also been on the front line of combining courses co-taught with the DEA and ASBP on how to deal with opioid drug issues.”

Dr. May spoke with Dr. Adams about Opioid Prevention Education Kick Off summits that are being held in communities throughout the state, where local residents hear educational facts and statistics, as well as personal stories from local residents about the opioid epidemic plaguing the state. She also told Dr. Adams about her passion, plans and goals for helping Drug Endangered Children.

“There are so many epidemics within this [opioid] epidemic,” said U.S. Surgeon General Dr. Jerome Adams. “I think one thing we need to ask is, how can we build resiliency in communities? We have a real opportunity here if we grab it and seize it today.”

Those in attendance also heard personal stories from Dr. Adams, including that members of his own family have been affected by the opioid epidemic. He said he has a brother who is currently serving time in a Maryland state prison for a burglary sentence, which was prompted by a drug addiction. [Read more of this story here: https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/ ]

Dr. Adams told the crowd that he was very pleased with the work and efforts Arkansans are making toward reversing the opioid epidemic in the state, so much so, that he plans to have his own staff mirror pages he glanced over from a information packet provided to him. He also encouraged those in attendance to speak out if they see someone having a possible issue with opioid medications.

“If you see something, say something,” Dr. Adams said. “I also encourage everyone to urge people to carry naloxone. It’s asafe drug, a readily available drug in Arkansas, and a drug which can save a life.”

Others in attendance at the meeting included: Carlton Saffa, Office of Arkansas Governor senior strategist and Board of Pharmacy liaison; Kaushik Kotecha, Smith Drug Wholesale Company in Spartanburg (partner in Labels Saves Lives campaign); Laura Monteverdi, KTHV 11 news reporter; and Matt Burks, Office of Arkansas Drug Director media specialist.

University of Arkansas student Trevor Villines envisions a future in which college campuses throughout the state tackle the opioid epidemic with expanded educational programs, medication drop-boxes on campuses, and through college recovery programs. As the Director of External Relations for the university’s Student Government Association (SGA) and President of the Registered Student Organization, Villines is seizing the opportunity to bring the vision to fruition.

“The opioid epidemic is a problem at every campus across the state and nation,” he said. “We have an opportunity to lead the state in addressing this issue. You’re going to hear, in the next coming months, that we are working on forming a joint effort.”

“We are going to try and work with student governments at other college campuses. Specifically we want to start within the U of A system, such as the University of Arkansas at Little Rock and other campuses across the state. We want to team up and talk with [university] administrators about college recovery programs and policies, as well as educational programs.”

To ensure this vision takes the correct course of action, Villines frequently communicates with state leaders, including Arkansas Drug Director Kirk Lane.

“Mr. Trevor Villines is a unique leader who has a vision to improve the quality of life of his student body, as well as communities throughout Arkansas,” Lane said. “The challenges of the opioid epidemic require unique leadership skills to build collaborative efforts and encourage change. I am proud of [Villines] achievements thus far, and those still to come.”

Villines said this semester, he’ll introduce a 3-step plan through the SGA: (1) Expand student policy to protect students in the event of an opioid overdose; (2) Create a College Recovery Program; and (3) To have a secure, permanent medicine drop box location on campus.

The first step includes the expansion of the Joshua Ashley-Pauley Act (an Arkansas good Samaritan law which gives immunity from prosecution for drug possession to someone seeking medical assistance due to a drug overdose) to further protect university students.

“The Joshua Ashley-Pauley Act can safeguard someone from an arrest and charges, but what about keeping them from being expelled from school or kicked off campus?,” Villines asked. “There are limitations to the Joshua Ashley-Pauley Act, and will be [limitations] to the student policy; however, we value saving lives most importantly.”

Arkansas Drug Director Kirk Lane and Villines have also been in communication with law enforcement agencies in Washington County, including the University of Arkansas Police Department, to supply officers with Narcan kits (which contain Naloxone medication designed to temporarily reverse an overdose due to an opioid).

The second step is to create a College Recovery Program for the University of Arkansas System. Villines has been researching and studying The Center for Collegiate Recovery Communities at Texas Tech University as a program to model. He said the Student Government Association “Definitely wants to do more in-depth research” of their program to learn its functions and how they’re funded.

“We’ve got to find a solution and a place in helping students overcome addiction,” Villines said. “We want them to build friendships on campus with people who encourage and support them during treatment. We want to see them saved and have a life change, and if we have a recovery program in place, we can get them the proper help they need.”

The third step is to expand education and awareness about the opioid epidemic. Aside from posting fliers around campus and starting awareness week campaigns, Villines envisions reaching out to various students at the places they congregate.

“We’ll go talk to people at the Greek-life houses, both sororities and fraternities,” he said. “But, we’ll also talk to various organizations. We want to meet with architect majors and engineers to discuss feasibility of project ideas. We’d like to get pharmacy and nursing students involved with volunteer work for the Arkansas Drug Take Back Day. We definitely want to get students involved.”

Villines is also in the discussion phase of having permanent medicine drop-boxes installed on college campuses in the near future. Though there are drop-box locations near many college campuses, he believes having them on campus would increase student participation in dropping off medicines.

“They could be placed securely in a student union or in a campus library, or any centralized area of campus,” Villines said. “We are going to work with the authorities to make sure it is a secure location, but also where students can easily drop them off so that [medications] aren’t floating around campus causing more harm to our students.”

These are just the first several steps Villines is taking toward initiating positive change against the opioid epidemic on college campuses. Not one to stop and rest for very long, he is constantly looking for new ideas to better improve communities throughout Arkansas.

“In my Student Government Association role, I’m responsible for meeting with legislators and state officials, such as Arkansas Drug Director Kirk Lane and the Governor’s staff,” Villines said. “I’m also planning to spend time with the Pulaski County Coroner to see the process for handling an opioid overdose.”

“I haven’t taken a decent break in 3 or 4 years because I’m always working and seeing how I can get involved. I’m always looking to take it up a notch. The bare minimum just doesn’t do it for me.”

Arkansas was well represented at the 2018 National Prescription Drug Abuse & Heroin Summit in Atlanta. We are all working together to make a difference! #ReverseTheOpioidEpidemic

https://twitter.com/ARdrugCzar/status/981597475093057536

By Nicholas Bakalar

March 7, 2018 New York Times

Opioids are no better than nonopioid pain relievers for treating the chronic pain of osteoarthritis, a clinical trial has found.

Researchers randomized 240 patients with moderate to severe chronic back pain or hip or knee osteoarthritis to either an opioid (morphine, oxycodone or hydrocodone) or to nonopioid pain relievers (such as Tylenol, topical lidocaine or nonsteroidal anti-inflammatory drugs). The study, in JAMA, used 11-point pain and function scales to measure the effect of treatment, with higher scores indicating poorer results. This is, the authors write, the first randomized trial of opioid therapy to report long-term pain and function outcomes.

At the end of 12 months, the opioid group scored an average 3.4 on the function scale, and the nonopioid group 3.3, an insignificant difference. On the pain scale, the nonopioid group did slightly better — 3.5, compared with 4.0 for the opioid group.

Unsurprisingly, there were significantly more medication side effects in the opioid group than in those who took nonopioids.

“Should we use opioids if nonopioids don’t work?” asked the lead author, Dr. Erin E. Krebs of the Minneapolis Veterans Affairs Health Care System. She answered her own question: “No. We tried four different nonopioids — don’t give up on them too soon — and we should also be using exercise and rehab for most osteoarthritic pain.”

Actual Report below

Question For patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, does opioid medication compared with nonopioid medication result in better pain-related function?

Findings In this randomized clinical trial that included 240 patients, the use of opioid vs nonopioid medication therapy did not result in significantly better pain-related function over 12 months (3.4 vs 3.3 points on an 11-point scale at 12 months, respectively).

Meaning This study does not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

Importance Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain.

Objective To compare opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects.

Design, Setting, and Participants Pragmatic, 12-month, randomized trial with masked outcome assessment. Patients were recruited from Veterans Affairs primary care clinics from June 2013 through December 2015; follow-up was completed December 2016. Eligible patients had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use. Of 265 patients enrolled, 25 withdrew prior to randomization and 240 were randomized.

Interventions Both interventions (opioid and nonopioid medication therapy) followed a treat-to-target strategy aiming for improved pain and function. Each intervention had its own prescribing strategy that included multiple medication options in 3 steps. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response.

Main Outcomes and Measures The primary outcome was pain-related function (Brief Pain Inventory [BPI] interference scale) over 12 months and the main secondary outcome was pain intensity (BPI severity scale). For both BPI scales (range, 0-10; higher scores = worse function or pain intensity), a 1-point improvement was clinically important. The primary adverse outcome was medication-related symptoms (patient-reported checklist; range, 0-19).

Results Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, −0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5]).

Conclusions and Relevance Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.

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