Controlled Substances
Why is this important to family physicians?
Family physicians can play a key role in recognizing risk factors for overdose or misuse in persons with chronic pain taking opioids, and to properly use prescription drug monitoring programs, drug screening, treatment agreements, or other methods to counter risk factors.
What recently happened on this topic?
In March 2022, Illinois released its Overdose Action Plan, which prioritizes outreach to and engagement with individuals who are at risk for both fatal and non-fatal overdose due to multiple drugs: synthetic opioids, heroin, cocaine, methamphetamine, and other substances.
Several pieces of legislation were also debated in 2022 involving controlled substances:
Adulterant Testing
House Bill 4556 expands public access to fentanyl test strips or other adulterants in controlled substances (note: distribution is limited to five tests in any single transaction, and may be dispensed by a “pharmacist, physician, advanced practice registered nurse, or physician assistant, or the pharmacist's, physician's, advanced practice registered nurse's, or physician assistant's designee”). IAFP supported the legislation, which is expected to be signed into law this summer
Prescription Monitoring Programs
Senate Bill 3920 was opposed by IAFP and did not pass this year. The legislation attempted to expand prescription monitoring programs (PMP) to all prescriptions and prescribing assessments beyond just Schedule II, III, IV, and V controlled substances, and opioid use disorder (note: opioid use disorder was added by Public Act 102-527 last year).
Opioid Receptor Antagonists
Senate Bill 2535 requires the dispensing of opioid antagonists (e.g. naloxone) pursuant to Illinois Department of Financial and Professional Regulation “written, standardized procedures or protocols.” The legislation also requires that “all prescribers of an opioid shall inform the patient that opioids are addictive and that opioid antagonists are available by prescription or from a pharmacy.” After several amendments monitored by IAFP, the legislation passed and is expected to be signed into law by the Governor this summer.
Key Points for Practice
Physicians should provide patient-centered care, including coordinating with other disciplines, to patients with chronic pain or dependence on opioids.
Practices should encourage their physicians to use medication-assisted treatment options for patients with opioid dependence.
Physicians are encouraged to use their state prescription drug monitoring programs for tracking purposes, to identify abuse or diversion, and recognize persons who might be at risk.
Methadone, buprenorphine, and naltrexone are used as opioid substitutes in medication-assisted treatment.
Ongoing education and guideline updates are necessary and available from the Illinois Academy of Family Physicians and American Academy of Family Physicians.