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Oxycontin
Tim gave a quick overview of ExCEL’s perspective on the oxycontin
issue. Generally, ExCEL members support efforts to control diversion
and abuse, and want to ensure that appropriate access to the drug is
not impeded. Some members are also concerned that the Governor’s
statements to the press and general publicity about oxycontin abuse
issues threaten to reverse positive trends in pain management with
opiates.
Joe Jacobs, MD gave a
history of his involvement in opiate pain management issues. About
one year ago, he ordered that methadone be placed on prior
authorization for PATH beneficiaries. This was done to ensure that
methadone would be used for limited pain management only, and would
not be used as a maintenance drug for former heroin users. To
address physicians’ concerns about prescribing the drug, he
recommended that physicians provide patients with a referral to a
pain management clinic; ask patients to sign an opioid use contract;
and conduct urine testing at regular intervals.
The state drug utilization
review (DUR) committee, charged with monitoring utilization of
prescription drugs by PATH beneficiaries, recently reviewed
oxycodone utilization patterns. The committee examined a list of 149
beneficiaries who had received oxycodone prescriptions from three or
more physicians. At some point in this process, the Governor made
his initial statement to the press that OxyContin would not be paid
for any beneficiary of the General Assistance program. When Dr.
Jacobs returned from a trip, he discussed the issue with the
Governor and they agreed that OxyContin would be placed on PA for
beneficiaries of General Assistance, Medicaid, VHAP and Dr. Dynasaur.
Dr. Jacobs said that his
intention was to use the prior authorization process to educate
physicians about appropriate prescribing of OxyContin. He described
his role as that of a “clinical advocate” for physicians in the PA
process, and assured the committee that bureaucratic requirements
would be as minimal as possible; that the PA form would be revised;
that approval time would be within 24 hours, with coverage for
weekends; and that six-month authorizations might be available under
special circumstances. He also acknowledged that public perception
was still a problem. He expressed his intention to improve pain
management for PATH beneficiaries by initiating reimbursement for
acupuncture services.
Tim mentioned that one
problem with the “Dear Provider” letter distributed with the PA
announcement was its recommendations for transitioning patients to
methadone. He cautioned that for patients taking high doses of
OxyContin, switching to methadone can cause respiratory depression.
Committee members thanked
Dr. Jacobs for his visit and expressed its desire to continue to be
involved in this issue.
Funding
Tasseli told the committee that she has been researching prospects
for private funding of ExCEL. She has also spoken with Cy Jordan,
Medical Director for VPQHC, about having VPQHC as the grant
administrator. Cy said that the VPQHC board recently decided to move
forward on extending its quality imporvement work to end-of-life
care, and might be very interested in administering the grant for
ExCEL. The committee agreed that VPQHC would lend to the ExCEL
proposal the strength of a stable and seasoned private, federal and
state grant recipient. Tim said that ExCEL members should make a
presentation before the VPQHC board soon, and develop a cooperative
venture proposal.
John mentioned that the
Kenneth B. Schwartz Foundation at Massachusett General Hospital is
interested in working with ExCEL and VEN to bring the Schwartz
Center Rounds to a Vermont hospital. He spoke with Marilyn Yager,
Executive Director of the foundation, about this possibility.
Membership
John told the committee that VEN did follow-ups last week with
representatives from each of the areas participating in VEN’s
two-day end-of-life seminar. He has an attendee list from that
event. He will mail a description of ExCEL and its resources to all
attendees who might be interested in becoming involved with ExCEL.
EMS DNR Orders
The committee expressed general frustration that the DNR order pilot
has not yet been implemented statewide. Bob Orr (sp.?) has submitted
a grant proposal to the Vermont Health Foundation to do a five-year
Physician Orders for Life-Sustaining Treatment (POLST) initiative.
The committee was concerned that this valuable proposal could have
the unintended consequences of significantly delaying action by the
Health Department on this issue.
Next Meeting
The next ExCEL meeting will be on Tuesday, September 18 from 2-4pm
at the Vermont Medical Society. The Commissioner of Health, Jan
Carney, MD, will be invited to the meeting to discuss the DNR order
issue.
Respectfully submitted,
Tasseli McKay for the Committee |
