UNM Project ECHO bites the dust

http://www.pharmaciststeve.com/?p=11648

Just six weeks after New Mexico announced that the overdose death rate had unexpectedly climbed, the state received a federal grant to target opioid overdoses with big data, better monitoring and more education. The New Mexico Department of Health said it received an $850,000-a-year grant for the next four years to enhance prescription drug overdose prevention. If renewed each year, the grant would provide $3.4 million for five more staffers working on overdose prevention initiatives.

“This funding allows the New Mexico Department of Health to develop new partnerships with the Board of Pharmacy and the Workers Compensation Administration. It will increase our capacity to reach communities with a high overdose burden,” Health Secretary Retta Ward said in a statement.

After two years of decline, the number of people in New Mexico who died from a drug overdose in 2014 hit 536, a jump of 20 percent over 2013. Officials say 265 of those deaths were the result of prescription opioids. The statewide rate of 26.4 overdose deaths per 100,000 population stands at one of the worst in the United States, along with West Virginia and Kentucky.

A major focus of the grant will be to better coordinate a Board of Pharmacy registry that is to be used by medical professionals who prescribe pain medication — an online tool called the Prescription Monitoring Program. The information is meant to help monitor patients who misuse pain prescriptions by shopping for several different providers around the state to write scripts.

But because there are seven medical occupations that can prescribe — from medical doctors to dentists — there are inconsistencies in how the database is used, as each reports to a different regulatory board where enforcement varies.

“Sometimes people get introduced to opioids in different ways. They’ll get injured and go see a medical provider and they’ll prescribe opioids. In cases, that person can then get addicted and overdose can result,” said Dr. Michael Landen, an epidemiologist with the state Health Department. “This whole pathway starts with that initial prescription and ensuring that prescription is appropriate is important.”

The grant will not only allow the state to capture more data from prescription writers, but also to deploy caseworkers into areas where they see “prescription hot spots” for drugs such as oxycodone, fentanyl, methadone, hydrocodone and buprenorphine.

“We’ll be able to use the data to work with individual doctor’s offices to improve prescribing in those offices,” Landen said.

Between 2001 and 2011, for instance, oxycodone sales in the state tripled, according to the Health Department.

Another emphasis for how the money is used will be to coordinate education efforts with the state Workers Compensation Administration, which has data on prescriptions for workers who were injured on the job — such as those with back ailments from heavy machine work or long-distance driving.

Landen said Washington state had success reducing overdoses in this population, which might come from a background where they haven’t seen addiction and don’t recognize it.

“We’d be able to analyze the data and make decisions on how to improve prescribing through their program,” he said.

Which means they will be seeking out any doctors prescribing over the maximum morphine-equivalent level and “educating” them about reducing dosages (and abandoning patients).

Some states, for instance, have looked at a “lock in” requirement, in which workers filling pain prescriptions have to use one medical provider and one pharmacy to better monitor usage.

Now only used in Medicaid, but soon coming to Medicare.

New Mexico is one of 16 states that successfully competed for the four-year grant from the U.S. Centers for Disease Control and Prevention. The grant is from a new program called Prescription Drug Overdose: Prevention for States that helps states address the ongoing prescription drug overdose epidemic.

How did the state successfully complete the grant if the programs didn’t work?

The Health Department also will collaborate with the Human Services Department to increase public awareness of potential harm from prescription opioid medications.

Landen said the grant also will pay for an evaluator who can assess the state’s effort on overdose prevention and determine what approach is working.

For a state with a medical cannabis program that’s about 8 years old, it’s surprising that overdoses keep rising. Other states’ programs have reduced overdose deaths by about 25%, yet not here in New Mexico. Perhaps it’s not surprising after all, considering the sad condition of New Mexico’s medical cannabis program.  Without a program that provides adequate access for all, there are few public benefits to be had.

And New Mexico is one of the poorest states in the country, so poverty plays a big role in overdose deaths and suicides.

Targeting opioids doesn’t seem like a very thorough plan. It leaves out so many drugs that contribute to overdoses, like alcohol, anti-anxiety drugs, muscle relaxers, and anti-depressants. And it leaves out one of the most important issues of all:  suicide.  (Way to honor National Suicide Day, Department of Health.) And what’s the deal with the Department of Health working with the Worker’s Compensation Administration? Easy to pick on the disabled, right?

Ironically, in January of this year, the University of New Mexico was announcing it might have found the “holy grail” of stopping opiate abuse (mostly centered around education):

https://painkills2.wordpress.com/2015/01/26/has-university-of-nm-found-the-holy-grail-of-stopping-opiate-abuse/

New Mexico’s Project ECHO is all about reducing opioid usage in chronic pain patients, and last I heard, is working with the Veteran’s Administration. UNM calls it a program for pain patients — I call it a program to treat addiction. The fact that the program doesn’t work just confirms my opinion that addiction in the chronic pain population is not the huge problem it’s made out to be. If you can’t find and don’t treat enough chronic pain patients that suffer from drug addiction, the program won’t work.

Ironic that the federal government is spending so much more money on programs that aren’t working, but I would say that most of the funding is really for the PDMPs, the blacklist for pain patients. And PDMPs are popular with the DEA, insurance industry, government agencies, and now the medical industry.

It’s also ironic that in October, 2013, Dr. Katzman authored a study about the epidemic of chronic pain. From someone who’s recognized the problem, all the way to today with Project ECHO, this doctor has taken a mighty long fall in a really short time. Here are my posts about the director of the program, Dr. Katzman:

https://painkills2.wordpress.com/?s=katzman

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