- Associated Press - Sunday, July 31, 2016

MADISON, Wis. (AP) - Wisconsin doctors should prescribe opioids sparingly, tell patients they could become addicted and avoid the drugs as the first option to treat pain, according to new guidelines the state Medical Examining Board recently adopted to combat heroin use.

The board, which monitors Wisconsin’s doctors, came up with the guidelines after Gov. Scott Walker signed a bill in March giving the panel the authority to develop best prescribing practices.

The state is among many in the U.S. grappling with an uptick in use of heroin, which opioid users often turn to when prescriptions run out.

“Many people believe that all medications prescribed by a doctor are 100 percent safe,” bill sponsor Republican Rep. John Nygren, whose daughter has struggled with addiction, said in a news release. “While a vast majority of medical professionals do a wonderful job educating their patients about the dangers of certain drugs, our state is still seeing an overprescribing problem - specifically with opioids.”

The guidelines, based on standards from the federal Centers for Disease Control, call for treating pain without drugs through yoga, exercise or other alternative treatments before turning to opioids. Once drugs are introduced, they should be prescribed in the lowest dose possible and in the quantity needed for the expected duration of the pain. Doctors also should consider people who are unwilling to obtain other treatment for their pain questionable candidates for opioids and document the rationale for giving them such prescriptions.



Doctors also should issue two prescriptions, each with specific refill dates, rather than one large prescription, which the guidelines believe with limit the potential for misuse.

Patients on chronic opioid therapy should give their informed consent after being told that the drugs can lead to addiction, overdose and death and agree to a treatment plan documenting how to avoid those outcomes. If evidence emerges that a patient is in danger or that their opioids are going to someone else, the drugs should be discontinued and the patient treated for withdrawal.

Doctors also should consider prescribing overdose antidote naloxone, best known by the brand name Narcan, for home use for patients at a higher risk of overdosing.

Dr. Tim Westlake, the MEB’s vice chairman, said Nygren’s bill was needed because the panel exists mostly to ensure doctors are competent and lacked the authority to issue practice guidelines. But the board wanted to do something about overprescribing opioids and heroin use.

According to the state Justice Department, the number of cases the state crime labs have handled that involve heroin has increased from 1,061 in 2013 to 1,141 last year. Nearly 200 people died of a heroin overdose last year, up 50 percent from 2014, according to statistics on the DOJ’s website.

“It’s just not an effective medical treatment and there’s so much harm that can come from it,” Westlake said. “How do we bend the prescriptive curve back? What we really want to do is have a cultural change.”

The MEB issued its guidelines in late July. The bill also gave the state podiatry credentialing and nursing boards as well as the dentistry and optometry examining boards the authority to issue opioid prescription guidelines, too, although they haven’t issued any yet.

Walker has signed 15 of Nygren’s bills aimed at combatting heroin use since 2014.

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Follow Todd Richmond on Twitter at https://twitter.com/trichmond1

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