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Arizona Opioid E-Prescribing Requirement


The Arizona Opioid Epidemic Act signed by Governor Ducey in 2018 mandates that prescription orders for a Schedule II opioid must be transmitted electronically to the dispensing pharmacy. Examples of Schedule II narcotics include: morphine, oxycodone, codeine, methadone, and hydrocodone.

Beginning January 1, 2019, each prescription order for a Schedule II opioid in Arizona’s six largest counties (Maricopa, Mohave, Pima, Pinal, Yavapai and Yuma) must be transmitted electronically to the dispensing pharmacy.

Beginning July 1, 2019, these same requirements go into effect in all other Arizona counties (Apache, Cochise, Coconino, Gila, Graham, Greenlee, La Paz, Navajo and Santa Cruz).

Providers, patients and families should expect that pharmacies will no longer accept written or printed prescriptions for Schedule II opioids starting January 1. 

Physicians and patients taking on the opioid crisis together

The practice of prescribing opioid drugs to patients following surgery has been the go-to standard in an environment where zero pain in recovery is the expectation. But with the fallout of opioid drug overuse painful to communities across the nation, both providers and patients are looking for alternatives.

Anesthesiologists from Old Pueblo Anesthesia, who practice at TMC, have been working to enhance their regional anesthesia program to provide additional options for patients.  If patients can keep opioid use to a minimum in those crucial first days after surgery, while reducing their pain and inflammation, the hope is that they can use fewer narcotics through their recovery period.

Opioids and Older Adults free seminar

Shoulder surgery, for example, is notoriously uncomfortable for some patients because the shoulder is engaged when a patient is standing or when laying down. Traditional anesthesia only lasts about 24 hours.

Now, in addition to direct injections to numb the area and block pain during surgery, physicians can place tiny catheters near the nerves that supply the shoulder with a local anesthetic to provide greater comfort for up to 3 days. The patient can care for the pump at home and throw it away when the anesthesia is depleted.

Dr. Robin Kloth said that Old Pueblo performed a comparison of patients with total shoulder replacement who used traditional pain relief and those who used interscalene catheter placement. “Over the course of the full 3 days, the catheter patients took less than half the narcotics that our compared group took in just a single day,” she said, adding patients also reported far less nausea.

Dr. Neesann Marietta concurred. “These techniques can really extend a patient’s pain relief, which greatly increases patient satisfaction. They can go home and sleep comfortably, which is so important for the healing process.”

And that’s just one example. For abdominal surgery, patients relied previously on epidurals that could only be used during their hospital stay. Now, anesthesiologists can do a block that provides local relief in the abdominal wall that will last up to 24 hours, and patients may be sent home the same day.

Colorectal and gyn-oncology surgeons are increasingly using a slow release local anesthetic that lasts up to 72 hours.

The colorectal program reports that between greater patient education, early ambulation and regional anesthesia, patients are seeing a decrease in patient length of stay by 1.3 days and an 88 percent decrease in morphine equivalent, given in the first 24 hours post-surgery.

“Both doctors and patients are becoming increasingly aware of the potential for the misuse of highly addictive pain medications and it’s important that we be part of this national discussion,” said surgical oncologist Michele Boyce Ley, who uses regional anesthesia as well as nonsteroidal medications such as Celebrex and gabapentin to help control pain for her patients having breast surgery.

Ley said her patients are doing so well, many are managing post-surgical pain with little more than Tylenol or ibuprofen.

“We have been working on this in earnest and getting training on these techniques because of concerns about opioid usage,” Kloth said. “Opioids have been the go-to solution for many years, in part because patients had high expectations of pain relief and because a bottle of Percocet is really cheap. These techniques are more labor intensive, but we’ve demonstrated value to the patient – and it’s the right thing to do,” she said.

Many patients also feel less lucid and less awake when using narcotics, which could delay physical therapy and rehabilitation.

Physicians have several opportunities to manage the use of narcotics, particularly important as patients leave the hospital with a plan for pain management during recovery.

Marietta said the techniques are not right for every patient and every case, but patients who are concerned about the potential for opioid misuse should have a conversation with their physician about pain control – and see if a nerve block would be appropriate.

Meet with Drs. Marietta, Kloth and Lambert Wednesday, November 15 as they discuss how anesthesiologists and patients can address this in practical terms at TMC for Seniors. More details available here.

Southern Arizona hospital coalition addresses opioid misuse in rural areas

SAHA.jpgA coalition of five independent Southern Arizona hospitals this week secured a federal grant to diminish opioid misuse and dependence across rural communities in Southern Arizona.

The Rural Health Network Development Planning Grant, which provides about $100,000 in support to the effort, comes through the federal Health Resources & Services Administration. The grant aims to:

  • achieve efficiencies by collaborating with behavioral health and police departments in rural communities
  • expand coordination of quality health care services by identifying shared communication strategies tailored for rural communities
  • strengthen the rural health care system in Southern Arizona by identifying opportunities for the Alliance to better address regional opioid misuse through the implementation of innovative collaborations and strategies

Formed in summer 2015, the Alliance consists of Northern Cochise Community Hospital, Copper Queen Community Hospital, Mt. Graham Regional Medical Center, and Benson Hospital. Tucson Medical Center is the founding member.

“Our Alliance has already demonstrated we can leverage existing relationships within our network to improve the care we deliver,” said Roland Knox, the chief executive officer of Northern Cochise Community Hospital who will lead the grant project. “Although this is a national struggle, Arizona has the fifth highest opioid prescription rate in the nation, and this award will allow us to work in a more coordinated way to improve outcomes for those grappling with this issue.”

Hope Thomas, the network director for the Alliance and TMC’s director of community programs, noted the challenges in rural communities are magnified because of more limited access to health and social services. Thomas noted an average of 26 percent of adults living in Southern Arizona’s rural counties report current prescription drug misuse and fatal opioid overdose in rural areas is as high or even higher than rates in metropolitan areas.

The grant award runs through May 2018.


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