Responsible Pain Management: Physicians look beyond pills to help chronic pain patients.

• Author: Simonelli, Isaac Stone
• Position: HEALTHCARE

As the opioid crisis deepens in Alaska and the nation, a growing amount of misinformation about the laws, regulations, and recommendations impacting primary physicians and pain management specialists abounds.

"There's a lot of misunderstanding and misconception--even at the level of physicians--as to what is legislated and what is suggested," explains Heath McAnally, MD, MSPH, a board-certified anesthesiologist, pain physician, and addictionologist at Northern Anesthesia and Pain Medicine in Eagle River. McAnally also co-authored the 2017 American Society of Interventional Pain Physicians opioid clinical practice guidelines and wrote a textbook on the subject for Springer Nature, a research, educational, and professional publisher.

"We've got this dual epidemic going on in this country right now with Institute of Medicine telling us that 100 million Americans suffer with chronic pain. Well, that number is increasing and so is the number of people on opioids," McAnally says. "Clearly, if you just look at it just from a prevalence of disease standpoint, we haven't helped."

State and Federal Legislation

In Alaska, the most recent legislative attempt to combat opioid addiction came last year when Governor Bill Walker signed into law HB159, which passed both the house and senate with sweeping, bipartisan support.

"I introduced this legislation as a part of our multi-pronged effort to fight the opioid epidemic facing Alaska, and I'm incredibly pleased to be able to sign it today," Walker said at the signing. "One death resulting from opioid abuse or misuse is too many, and we must tackle this issue head-on as Alaskans. HB159 is an example of healthcare providers, legislators, and Alaskans pulling together to build a safer state as a community."

In February 2017, Walker declared a public health crisis in order to combat the state's opioid epidemic.

"This disaster declaration is an important first step in addressing our public health crisis, which has devastated too many Alaskan families," Walker said. The declaration established a statewide Overdose Response Program, enabling wide distribution of the life-saving drug naloxone, a medication designed to rapidly reverse opioid overdose.

In addition to strengthening reporting and educational requirements for healthcare providers, HB159 limits first-time opioid prescriptions to a seven-day supply, though exceptions can be made if there are circumstances where it's unreasonable to ask a patient to return in a week to refill a subscription. In much of the Lower 48, this possible loophole for abusing the law would be minimal. However, the rural nature of Alaska presents plenty of reasonable exceptions to the prescription limit.

On the federal...