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IHS Implements Groundbreaking New Policy Regarding Opioid Prescribing

by Mary Smith, IHS Principal Deputy Director

Effective immediately, the Indian Health Service will require healthcare providers working in IHS federal-government-operated facilities, including doctors, pharmacists, nurse practitioners and other providers who prescribe opioids, to check state Prescription Drug Monitoring Program (PDMP) databases prior to prescribing and dispensing opioids for pain treatment longer than seven days and periodically throughout chronic pain treatment —one of the first such actions by any federal agency involved in direct medical care.

IHS is continuing its efforts to combat prescription drug abuse in American Indian and Alaska Native communities by implementing this policy. Checking a PDMP before prescribing helps to improve appropriate pain management care, identify patients who may have an opioid abuse problem and prevent diversion of drugs. PDMPs are state-based, electronic databases that collect data on controlled medications dispensed by registered pharmacies operating within the state. 

This policy formalizes the IHS practice of ensuring safe and appropriate prescribing practices for prescription medications, including opioids, for more than 1,200 IHS prescribers.

This announcement today is part of several new actions the U.S. Department of Health and Human Services (HHS) is announcing Exit Disclaimer: You Are Leaving . (Read the White House fact sheet on more actions addressing the U.S. opioid epidemic Exit Disclaimer: You Are Leaving . ) A multi-million dollar new investment in new opioid abuse and pain treatment research was announced, along with a report on the opioid research Exit Disclaimer: You Are Leaving  currently being conducted or funded by HHS agencies. Finally, a Request for Information Exit Disclaimer: You Are Leaving  has been issued seeking comment on current HHS prescriber education and training programs and proposals that would augment ongoing HHS activities in this space.

‎IHS data indicate that the rate of drug-related deaths among American Indians and Alaska Natives has increased dramatically in recent decades. The rate of these deaths increased from five per 100,000 population (adjusted) in 1989-1991 to 22.7 per 100,000 in 2007-2009. The rate among American Indian and Alaska Native people is almost twice that of the general population; drug-related deaths were 12.6 per 100,000 population for the U.S. all races population in 2007 to 2009. According to the Centers for Disease Control and Prevention (CDC), another part of HHS, the rates of death from prescription opioid overdose Exit Disclaimer: You Are Leaving  among American Indian or Alaska Natives further increased almost four-fold from 1.3 per 100,000 in 1999 to 5.1 per 100,000 in 2013.

Checking PDMPs is part of continuing IHS efforts on opioids, including work to equip clinicians with what they need to provide quality care to American Indian and Alaska Native patients, and including an announcement in December that IHS will be training and equipping hundreds of BIA law enforcement officers with naloxone, an opioid overdose-reversing drug.

The PDMP policy is part of an overall strategy for HHS. These actions will build on the HHS Opioid Initiative Exit Disclaimer: You Are Leaving , and the National Pain Strategy Exit Disclaimer: You Are Leaving . At IHS, our ongoing efforts to support our clinicians are coordinated with the IHS Prescription Drug Abuse Workgroup, which makes pain management best practices resources available to clinicians and provides training.

Ms. Smith, a member of the Cherokee Nation, leads IHS, a nationwide health care delivery program responsible for providing preventive, curative and community health care to approximately 2.2 million American Indians and Alaska Natives.

Mary Smith, IHS Principal Deputy Director