TR file photo Pictured is the sign outside of McFarland Clinic Northside, in Marshalltown.

Editor’s Note: This is part one of a two-part series on opioid abuse. Part one features strict new rules issued on prescribing the drugs. Part two details how one large pharmacy business changed their polices in honoring opioid prescriptions.

Iowa physicians and their designated agents prescribing opioids have new rules to follow.

The rules published last week by the Iowa Board of Medicine — a physician’s governing board — mandate prescriber registration and also address what is commonly known as “doctor shopping.”

The latter is a practice by patients who attempt to see multiple medical providers in hopes of securing more opioids. The rules also help implement the Iowa legislature’s House File 2377, otherwise known as the “Opioid Bill,” signed into law by Gov. Kim Reynolds in May 2018, according to the IBM website.

Iowa, among other states, have attempted to address the national opioid abuse crisis which has resulted in countless deaths, debilitating injuries and millions of dollars in lost wages.

In 2016, there were 183 opioid-related overdose deaths in Iowa a rate of 6.2 deaths per 100,000 persons compared to the national rate of 13.3 deaths per 100,000, according to the National Institute of Drug Abuse. Since 2012, the number of deaths attributed to heroin overdose have increased from 14 to 47 deaths. In the same period, synthetic opioid-related overdose deaths rose from 36 to 58 deaths.

Registration/opioid use history

Mandated registration means a physician or physician’s designated agent who is going to prescribe opioids must register with a Prescription Monitoring Program at the time of initial registration or renewal of a Controlled Substance Act Registration (CSAR) with the Iowa Board of Pharmacy.

The IBM rules also ensure physicians and other prescribers have access to a patient’s opioid use history.

Prescription Monitoring Programs are organized by state and contain all information about a patient’s controlled substance prescription history. For example, if someone is obtaining opioids from multiple prescribers or “doctor shopping” a physician registered with Prescription Monitoring Program would be able to check.

Finally, every controlled substance prescription will need to be an electronic prescription starting January 2020.

“The prescription shall be transmitted to a pharmacy by the physician or the physician’s authorized agent in compliance with federal law and regulation for electronic prescriptions of controlled substance,” said IBM. Anyone prescribing too many/too high doses of opioids can be disciplined by the IBM board.

McFarland Clinic

Dr. Michael Kitchell of McFarland Clinic of Ames is Quality Medical Director. He said they initiated stricter guidelines at all Iowa McFarland Clinic locations several years ago regarding the issuing of opioid prescriptions.

“We mandated our physicians and nurse practitioners to check the Prescription Monitoring Program every time they write a new prescription,” Kitchell said. “We believe firmly in our policies … in not giving opioids to patients who do not need them, and making sure patients who do need them are getting prescriptions. Some cancer patients certainly qualify for the opioid oxycodone. Surgery patients may qualify for a short-term opioid prescription.”

Kitchell said McFarland Clinic facilities system-wide is committed to the practice.

“We have reduced the total number of opioid prescriptions by more than 20 percent,” he said. “We at McFarland Clinic have been reducing the number of opioids prescribed as well as the number of patients receiving them.”

Kitchell said there exist approbate alternative methods to some pain relief, such as physical therapy, or other treatment modalities.

“McFarland has an Opioid Committee that make recommendations to physicians who prescribe the medications or to those who do so frequently.

Kitchell has been a practicing physician for 39 years, and has served as Quality Medical Director three years. Previously, he served as the clinic’s chairman of the board. Headquartered in Ames, McFarland Clinic operates two clinics in Marshalltown.

UnityPoint Health

UnityPoint Health-Marshalltown operates a 49-bed hospital in Marshalltown and clinics in Conrad, Marshalltown, State Center and Tama-Toledo.

It operates facilities throughout Illinois, Iowa and Wisconsin.

“UnityPoint Health adheres to all state laws and Board of Medicine requirements regarding patient care,” Heather Nahas said. She is director of communications for UnityPoint at Home. “During 2018, several UnityPoint Health providers participated in a pilot program allowing them to electronically transmit prescriptions for controlled substances directly to participating pharmacies.”

The pilot was an opportunity to prepare for electronic prescribing of all prescriptions, including controlled substances, which will be required by Iowa law starting Jan. 1, 2020. “We are now actively preparing our organization for this change by assisting providers with the mandatory education, training and registration requirements,” Nahas said. “Our providers are currently using the Prescription Monitoring Program to manage patients on controlled substances and workflows are programmed into our electronic health record.”

Prescription Monitoring Programs

A physician is not required to utilize a Prescription Monitoring Program to assist in the treatment of a patient receiving inpatient hospice care or long-term residential facility patient care, according to the IBM release. An order issued in an inpatient hospital setting is not considered a prescription for the purposes of these rules. Patient safety is adequately protected in an inpatient hospital setting and physicians caring for patients in an inpatient hospital setting do not prescribe.

Medical providers also need to complete continuing education specifically related to prescribing opioids.