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Patient info tool to assist doctors prescribing opioids
Deseret News - 12/4/2017
By Ben Lockhart
SALT LAKE CITY - The Utah Division of Occupational and Professional Licensing on Wednesday showcased a new online patient dashboard that health providers can use to monitor opioid use before making prescription decisions.
The feature, set to go live today, tracks a metric called "morphine milligram equivalents" that represents a patient's current level of opioid use; the number of prescribers the patient has visited for opioids within the last six months; and the number of pharmacies the patient has visited in that time frame.
The tool will also inform doctors whether the patient's prescriptions indicate the possibility of "an active benzo opioid combo," a mixture of drugs considered dangerous.
Francine Giani, executive director of the Utah Department of Commerce, which oversees the state's licensing officials, called the dashboard an example of "government ... assigning resources to tackle the problem" of widespread opioid addiction.
"The opioid epidemic has rightly received much attention in recent years, not only by the public and the media, but also the government," Giani told the Health and Human Services Interim Committee on Wednesday.
Under the direction of Gov. Gary Herbert and state lawmakers, she said, state experts have the goal of reducing "opioids prescribed and dispensed, per prescription, from 78 morphine milligram equivalents to below 50."
The patient dashboard project, which integrates patient records with the existing state Controlled Substance Database, was a major component of a $550,000 undertaking enabled by a federal grant, according to the Department of Commerce.
The new online resource was enthusiastically welcomed by legislators, including Sen. Brian Shiozawa, R-Cottonwood Heights, who is an emergency room doctor.
"It would be very powerful ... if we could just say, 'You know Mr. Smith, you show a very high risk probability in the number of prescribers, pharmacies and the types of medication that you're getting,' and actually show that," Shiozawa said.
Doctors who use the tool can opt to refer patients to a substance use disorder specialist for further treatment.
Utah is among the states most deeply impacted by opioid abuse, said Anna Fondario, data manager for the Department of Health's Violence & Injury Prevention Program. Intermountain Healthcare has estimated that 7,000 opioid prescriptions are given out daily in Utah and that 85 percent of people addicted to heroin were first addicted to prescription painkillers.
About two Utahns die each day from an opioid overdose, according to statistics kept by the Centers for Disease Control and Prevention.
In recent years, "the rate of opioid prescriptions being dispensed has decreased overall," Fondario said, but work remains to be done in some areas of the state, such as Carbon and Sevier counties. She said prescription opioid overdose deaths have decreased since 2014, but the number of heroin overdose deaths has increased since 2011.
The new patient dashboard can also allow prescribers to view summaries of a patient's prescriptions dating back five years, though data beyond six months is not considered a primary metric alerting to risk. So far, data from nine other states about prescribing histories is also available.
Rep. Sandra Hollins, D-Salt Lake City, asked whether there was any way to also track data about abuse of illicit opioids such as heroin.
"I am concerned about that uptick (in illicit use) that has been going on," Hollins said.
David Furlong, chief investigator for the Division of Professional Licensing, responded that "we do get data from the courts on arrests." He also said hospitalizations for any nonfatal opioids overdose is also tracked for patients at least 12 years old.
Hemp extract study
Also Wednesday, Dr. Francis Filloux, chief of the Division of Pediatric Neurology at the University of Utah, presented to the committee the results of a $40,000 study into the effects of a hemp extract treatment made legal for treatment of epilepsy in July 2014.
Hemp extract registration cards have been made available to 231 Utahns since that time. A survey the U. sent out this spring to 139 Utahns who held a card as of a year ago elicited responses from 46 of them who detailed the substance's effect on their seizures, Filloux said.
"The questionnaire asked families and patients to describe their impression of the effect of hemp extract on seizure frequency," he told the committee. "We also asked about seizure severity, examining how bad or intense the patients perceived the seizures to be."
In all, 22 percent of respondents reported that the hemp extract "almost completely controlled" their seizures, Filloux said. About 29 percent reported seizures being reduced noticeably, but by less than 50 percent, while 22 percent reported minimal improvements.
No change or increased frequency of seizures was reported by 17 percent of respondents, and no respondents reported seizures had completely stopped, according to Filloux.
"The degree of improvement seems modest at best, according to patients responding to the survey," he said.
Those who took the survey also answered questions about the severity of their episodes since using hemp extract.
"About 30 percent of respondents reported no improvement in seizure severity, whereas 30 percent reported that seizures were 'a whole lot better,' so it's kind of split there," Filloux said.
Among minors using the extract, the rate of those who reported a significant improvement in seizure severity was about twice that of adults, he said.
Roughly 1-in-5 respondents reported some sort of side effect to using hemp extract, with the most common being tiredness, diarrhea and changes to appetite.
"It's important to note no serious, life-threatening adverse effects were reported," Filloux said.
Nearly two-thirds of respondents reported an "additional benefit" from the hemp extract outside of helping with seizures, according to Filloux. Chief among those were "improved sleep, better alertness (and) better communication," he said.
Filloux cautioned that the U.'s findings had significant limitations.
"The answers to these questions depend on the perceived improvement as reported by patients or by their caretakers ... not by any objective measures we could generate such as seizure counts and so forth," he said.
Credit: By Ben Lockhart Deseret News