“This disaster declaration is an important
first step in addressing our public health
crisis, which has devastated too many Alaskan
families,” Walker said. The declaration
established a statewide Overdose Response
Program, enabling wide distribution of the
life-saving drug naloxone, a medication
designed to rapidly reverse opioid overdose.
In addition to strengthening reporting and
educational requirements for healthcare providers, HB159 limits first-time opioid prescriptions to a seven-day supply, though exceptions
can be made if there are circumstances where
it’s unreasonable to ask a patient to return in
a week to refill a subscription. In much of the
Lower 48, this possible loophole for abusing
the law would be minimal. However, the rural
nature of Alaska presents plenty of reasonable
exceptions to the prescription limit.
On the federal level, since the Harold
Rogers Prescription Drug Monitoring Program
(PDMP) mandate (which provides funds to
states that establish PDMP systems, though
it does not specify any action that must be
carried out based on information collected)
went into effect, there has been very little
legislative action, McAnally notes.
However, physicians’ practices are governed
by more than federal and state law.
“Most of what is happening at a national
level is advisory oversight,” McAnally says.
“Professional societies and even some gov-
ernmental organizations, such as the Center
for Disease Control and Prevention [CDC],
put out a big statement in 2016 saying we
have a huge problem.”
The CDC guidelines provide recommen-
dations for primary care clinicians who are
prescribing opioids for chronic pain outside
of active cancer treatment, palliative care, and
Information from the CDC addresses when
to initiate or continue opioids for chronic
pain; opioid selection, dosage, duration,
follow-up, and discontinuation; as well as
assessing risk and addressing the harm of
The CDC has been tracking chronic pain
issues and opioid abuse for decades. The
2016 guidelines, which are not law, note
that an estimated 20 percent of patients with
non-cancer pain symptoms or pain-related
diagnoses receive an opioid prescription.
“In 2012, healthcare providers wrote 259
million prescriptions for opioid pain medica-
tion, enough for every adult in the United States
to have a bottle of pills,” the guidelines state.
To create the guidelines, the CDC basically
distilled a consensus from experts throughout the nation, McAnally explains.
“The guidelines are basically saying: This
is how we feel chronic opioid therapy should
be used. But that’s not law, it’s expert opinion.
“Having said that, we as physicians are
also judged in accordance with what is called
standard of care. And we do our best to police
ourselves as well. Just because something isn’t
law doesn’t mean it isn’t important. These
guidelines are all important.”
Aside from legislation and clinical guidelines, there is also public sentiment.
“The pendulum has swung quite a bit over
the last ten to fifteen years where prescribing
opioids is kind of taboo behavior right now,”
says McAnally, who considers himself a conservative when it comes to issuing prescriptions.
Multiple Methods of Management
“There are lots and lots of different disciplines
“I actually left the OR and went into full-time pain management
because I perceived, had been perceiving for several years, that
we’re having a problem here with how we’re managing pain.
And that we’re getting people hooked on opioids. And their
pain isn’t getting any better.”
MD, Northern Anesthesia and Pain Medicine
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