Minn. finalizes guidelines for opioid prescriptions

Opioid tablets
An arrangement of pills of the opioid oxycodone-acetaminophen.
Patrick Sison | AP 2017

Updated: 12:11 p.m. | Posted: 4:00 a.m.

After three years of work, the state of Minnesota has finalized guidelines for how doctors should prescribe opioid painkillers that include starting certain patients on the lowest effective dose.

The recommendations were released as Gov. Mark Dayton announced new pilot programs to combat opioid abuse throughout the state. He also pushed the Legislature to pass more funding for prevention and treatment programs.

The new guidelines recommend that doctors prescribe the lowest effective dose of opioids when using them for acute pain and keep close tabs on patients afterwards. It also recommends that prescribers avoid prescribing opioids for new chronic pain patients and help manage patients who are already on opioids.

The guidelines are necessary because the number of opioid overdoses is still being driven by overprescribing, said Department of Human Services acting commissioner Chuck Johnson.

"The guidelines provide a framework for reducing opioid prescriptions," Johnson said, "ensuring consistent standards and safety for how opioids are used, when they are necessary, and delivering compassionate support to people who do need long-term opioid therapy."

The Opioid Prescribing Working Group that came up with the guidelines was formed in 2015, and included doctors, state officials and law enforcement representatives.

The medical industry in the state is supportive of the guidelines, said Rahul Koranne, chief medical officer of the Minnesota Hospital Association.

"These guidelines will really clarify and will be a way to start conversing with our patients, to say, 'Hey, everybody is following these same guidelines, so let's talk about your pain, let's try other things, let's not jump to opioids,'" Koranne said.

The state wants to encourage health providers to voluntarily adopt the guidelines, but Medical Assistance and MinnesotaCare providers who prescribe opioids excessively will be required to enroll in programs to help them meet the new standards.

A draft of the guidelines was released in December.

'Penny-a-pill' bill reconsidered in Senate next week

Dayton has identified a number of areas where he'd like to see legislation to address opioid abuse and overdose. He's been a vocal supporter of the "penny-a-pill" legislation, which would charge pharmaceutical companies for every opioid they sell in Minnesota and use those funds for prevention, treatment and social services tied to the opioid epidemic. It's run into opposition from pharmaceutical companies and some business groups.

State Sen. Julie Rosen, R-Vernon Center, is the bill's author in the Senate. She plans to again bring the bill up for consideration in her committee on Tuesday, and said the fee on pharmaceuticals is still in the legislation. But she's also exploring an increase in the licensing fees that pharmaceutical companies are asked to pay to do business in Minnesota.

Rosen said talks with pharmaceutical companies are ongoing, but that the industry hasn't yet come forward with any constructive funding solutions.

"I'm getting tired of the pushback, and the lack of true, sincere interest in helping us solve this crisis," Rosen said of the pharmaceutical companies.

State Sen. Chris Eaton, DFL-Brooklyn Center, said it's unacceptable that the state's taxpayers would be asked to cover more costs associated with the opioid epidemic.

"To me it's really important that the pharmaceutical companies contribute to the crisis they committed," Eaton said. "They've made billions off the addiction and death of many of the people in our state."

The House version of the bill no longer contains the fee on pharmaceutical companies, but author Rep. Dave Baker, R-Willmar, said it's still a possibility, and that his main concern was passing funding for programs in the bill somewhere.

Funding for pilot programs in greater Minnesota

The state of Minnesota also announced $700,000 in grants to eight communities in outstate Minnesota to reduce opioid abuse and support treatment.

Minnesota Department of Health Commissioner Jan Malcolm said the grants are modeled on a pilot program at CHI St. Gabriel's Health in Morrison County, which she said combines both clinical and community-based strategies to reduce opioid overdose deaths.

"This is a really promising model," Malcolm said. "We're going to be able to build on this St. Gabriel's, Morrison County model, do some further testing of its robustness so hopefully we can roll it out to every community in the state in future years."

The Morrison County program was recognized late last year by the American Hospital Association for "rooting out the economic and social barriers to care" and collaborating with others in the community to increase the effectiveness of treatment.

The approach, according to CHI St. Gabriel's Health, creates teams of doctors, nurses, law enforcement officials and social workers to address opioid abuse or dependency. The program has also expanded patients' access to medications that can assist them in treatment.

The grants are funding programs in Douglas, Redwood, Chippewa, and St. Louis counties, among others. The money will be used to pay for teams of medical professionals including pharmacists, doctors and social workers, that will coordinate patient care.

The grants are funded by $1 million in funding approved by the state Legislature last year.

Correction (April 27, 2018): An earlier version of this story misidentified Chuck Johnson's title.

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