Deaths resulting from narcotic overdoses now exceed the number of those who die from car accidents in Hawaii. Throughout the United States, narcotic abuse, diversion and addiction are on the rise.
To stem the tide, Senate Health Committee Chairman Josh Green (D, Naalehu-Kailua-Kona) has advocated for the formation of a Hawaii Narcotics Policy Working Group.
Dr. Scott Miscovich, a family physician from Kaneohe and president of the Work Injury Medical Association of Hawaii, was charged with appointing a group of leading medical experts within our state to evaluate and propose upgrades to existing policy.
Working group members represent stakeholders across the health care industry and include well-trained and highly respected clinicians accustomed to the management of chronic pain: Dr. Linda Rosen, state director of health; and Keith Kamita, chief special agent at the Narcotics Enforcement Division in Hawaii. Having been a founding member of the Work Injury Medical Association of Hawaii, I have observed Miscovich’s skillful leadership and capacity to build consensus and, as such, have had high hopes for the success of the group.
This team has evaluated laws and guidelines currently in place in Hawaii and begun to compare them with existing and pending narcotic laws in the other 49 states.
A study is also underway to analyze "best practices" and evidence-based medical guidelines and policies in the U.S. and abroad not only for pain management, but also for prevention and treatment of addiction.
The goals of the working group include recommendations for comprehensive reform of narcotic policy in time for the 2015 legislative session. Companion recommendations for reform also will be made to the state Board of Medical Examiners relating to the treatment of pain and for oversight of health providers who treat chronic pain.
The group is a critical public-private initiative that will leverage the cumulative experience of experienced health providers, the state Department of Health, law enforcement, top legislators and relevant professional state boards.
It will save lives.
Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
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The Hawaii Narcotics Policy Working Group’s preliminary recommendations to prevent drug abuse:
1. Standardized pain contracts: A proposed stated-endorsed Provider-Patient Agreement is under development. Key elements might include urine drug testing and a requirement that patients use a single pharmacy.
2. Mandatory use of the state Prescription Drug Monitoring Program by all health providers.
3. Broad expansion of the use and availability of naloxone (an antidote), which can be lifesaving in the face of an opiate overdose.
4. Mandatory urine drug testing to identify those who are using drugs that were not prescribed and to ensure that medications that have been prescribed are being taken as per plan and not diverted or sold.
5. Mandatory Continuing Medical Education for health providers to maintain state prescribing authority especially for controlled and pain medications.
6. Capping the amount of acetaminophen (Tylenol) an individual can be prescribe to not exceed 3 grams per day.
7. Evaluating the definitions of a "Qualified Pain Clinic" and "Qualified Pain Provider."
8. Recommendation that a daily maximum dose to not exceed 120 mg ME (morphine equivalents) of opioids that may be prescribed by a non-pain-trained provider.
9. Increase of state-sponsored "Drug Take Back" programs.
10. Funding increases for the state Narcotics Enforcement Division to support these programs.
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