Doctor speaks about how the Opioid Epidemic Act may help

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Arizona Gov. Doug Ducey made one of his New Year’s resolutions to crack down on the opioid crisis in the state, which killed at least 800 Arizonans last summer.

“If the policy is going to have any effect on the current opioid crisis, it’s going to need to be far-reaching and comprehensive,” Dr. Luke Peterson from Banner University Medical Center says. “I think that this Opioid Epidemic Act is a good first step, (but) it’s not going to be the solution.”

Peterson says the number one killers of Arizonans right now is the overprescribing of pills. At the moment, the state is in a position where the current number of prescribers and the number of providers that can treat opioid use disorder are lacking, according to Peterson. He says it would help to have more physicians and other providers to step in and screen, diagnose and treat these patients.

There are some critics of the act saying that politicians are telling doctors how to do their job, which Peterson disagrees with. He says there are some provisions that exclude some doctors who don’t have internet capabilities.

Many are blaming the “bad actors” for giving all the doctors a bad name. While it’s easy to find a scapegoat, Peterson says, “the reality is, all of us are to blame.” Those who are overprescribing come from primary care settings and family doctors. Peterson says everyone should take responsibility to solve this multifaceted problem.

Legislators were on Arizona Horizon last week to discuss the opioid epidemic and how Ducey plans on helping it.

Ted Simons: A special session of the Arizona legislature recently passed sweeping changes to state regulations on Opioids. The goal to fight an epidemic that has killed over 800 in Arizona since last summer. Joining us now with the physicians perspective of the new rule is Dr. Luke Peterson of Banner University’s Medical Center of addiction recovery clinic. Thank you for joining us. Your thoughts on the Arizona Opioid epidemic act?

Luke Peterson: If policy is going to have any effect on the current opioid crisis it needs to be far reaching and comprehensive. I think this Opioid epidemic act is a good first step. It is not going to be the solution or the definitive treatment for the current situation but it is a good first step.

Ted Simons: What would you like to see as a second step?

Luke Peterson: For a little background, the current epidemic, I like to look at it in a framework of three epidemics. There is the overprescribing epidemic of prescription pills that are being used. Those are the number one killers of Arizona residents now. There are two other epidemics, the heroin epidemic and the rising fentanyl epidemic. This set of legislation really tries to address the overprescribing however we need more treatment for the other two, the fentanyl and heroin epidemics.

Ted Simons: $10 million to treat uninsured addicts and letting patients stay longer in treatment facilities. Those sort of things, good, could be better.

Luke Peterson: Exactly. We are in a current state where the number of prescribers and number of providers that can treat Opioid use disorder are lacking. There is a huge gap especially in our access population that is being hit by this significantly hard. So we need more physicians and other providers stepping up to screen, diagnose and treat these patients.

Ted Simons: There was some concern here with lawmakers telling doctors what to do in terms of prescription, in terms of limits, these sorts of things. Is that a valid concern?

Luke Peterson: I think it is always a concern when a bill inhibits a physician's patient-doctor interaction. This bill does have exclusions for those patients who have had trauma, who are at the end of life hospice care, post-burn victims. There are some provisions that will protect a lot of concerning, extreme situations but I think there potentially could be some cases where a patient has to come back early to a physician to get a prescription filled because there is now this five-day limit.

Ted Simons: Yes. Does it overburden doctors? I know electronic prescriptions required. I know some rural areas may not have the facilities, the where with all to deal with that. Is that a concern?

Luke Peterson: We are moving toward an electronic system in health care and there is provisions in here that would exclude the doctor offices that don't have internet capability. The point of that piece is to prevent the written prescription from being tampered with and diverted.

Ted Simons: Does it make sense for all these rules and regulations on doctors if only a small number of doctors are at fault? It sounds like there are a few doctors prescribing a whole lot of pills. Are we using an elephant gun here where it is not necessary?

Luke Peterson: That is a great question because it is really easy to find a scapegoat and say these bad actors are the number one cause of this epidemic but the reality is that all of us are to blame. The lion's share of opiates prescribed are coming from primary family care settings. So this is not just those people that are prescribing irresponsibly. This is just the whole medical society has been prescribing irresponsibly for a long period of time.

Ted Simons: Is that laziness? Is it ignorance? Something more dastardly? What’s going on?

Luke Peterson: It is a multifaceted problem. Years ago when I was in training with my attendings they never prescribed high doses of Opioids. It was not part of the culture. Then there were regulations made where we need to treat pain as a fifth vital sign. Then there was a culture of prescribing that really came from a lot of the pharmaceutical companies that encouraged doctors to prescribe and these were safe medications when, in actuality, that was based on poor literature and poor evidence. Those are driving forces. We are also looking at a situation of overprescribing because these medications treat pain. These medications they treat more than just -- they act in the same part of the brain that endorphins cause to cause euphoria and feel at ease and decrease anxiety and help you sleep. These are all side effects that can lead to people misusing them or having an unhealthy psychological dependence on these medicines.

Ted Simons: We will see where we go and hopefully get some of the numbers down. Thank you so much for joining us. Good to have you here.

Dr. Luke Peterson: Banner University Medical Center

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