Preventing Drug Overdoses in Oklahoma Drug overdose deaths in Oklahoma have risen sharply during the past decade, according to Oklahoma City Addiction Medicine physicians Hal Vorse, MD, and Billy Stout, MD.
Between 2002 and 2010, the Oklahoma Bureau of Narcotics and Dangerous Drugs Control (OBN) reports the number of overdose deaths in the state rose from 470 to 814 per year. Preliminary data indicates there were at least 795 drug overdose deaths in Oklahoma in 2011. Seventy-seven percent of the deaths were due to the use of prescription drugs in combination with other prescription drugs or alcohol. Drug overdose deaths now annually outnumber automobile accident fatalities in the Sooner State. Many physicians consider such drugs. relatively harmless when used alone.
Many physicians consider such drugs as benzodiazepines, hydrocodone and carisoprodol relatively harmless when used alone. When used in combination, however, they can become very lethal. All drugs which depress the central nervous system become synergistic in their toxicity when used together. The Oklahoma State Medical Examiner's Office reported the following drug overdose death statistics for 2009: • 351 single agent deaths.
• 441 two or more agent deaths.
• Benzodiazepines (Xanax, Valium), 10 single agent deaths; 181 deaths with one or more other agents.
• Carisoprodol (Soma), 2 single agent deaths; 46 deaths with one or more other agents.
• Tramadol (Ultram, Ultracet), 5 single agent deaths; 14 deaths with one or Board of Medical more other agents. • Hydrocodone (Lortab, Vicodin, Norco), 20 single agent deaths; 124 deaths with one or more other agents.
101 N.E. 51st Street Since the Drug Enforcement Agency (DEA) classifies hydrocodone as Oklahoma City, OK a Schedule III rather than a more tightly controlled Schedule II drug, some physicians may conclude that it is safer to use. It is not safer, particularly when used with other depressant drugs. The State of Oklahoma only recently designated Tramadol and cariosprodol as controlled dangerous substances (CDS). Therefore many physicians may Continued on page 2 Overdose, continued from front page
assume they are relatively harmless. However, they are
• Make sure patients understand they must addictive and also carry a significant risk of overdose.
never take two or more substances at the Many overdose deaths are preventable. Here are a same time—including alcohol—which depress few recommendations that could save hundreds of lives: the central nervous system.
• Check the OBN's Prescription Monitoring • Do not prescribe opiates and benzodiazepines Program's (PMP) history report on all at the same time or decrease the dosage of patients, particularly those taking controlled each if they must be given together.
substances. Be sure patients are not receiving prescriptions from other providers.
*See "Upcoming CME Programs" on back page • Determine if the patient has a history of substance abuse.
Extended-release / Long-acting Opioids REMS
While extended-release and long-acting (ER/LA) ER/LA opioid analgesics with patients and/ opioid analgesics are approved for the management or their caregivers every time you prescribe of moderate to severe chronic pain in appropriately these medicines. You may download the Patient selected patients, these medications also are Counseling Document on Extended-Release/ associated with serious risks and are the center of a Long-Acting Opioid Analgesics (and also learn major public health crisis due to increased misuse, more about this REMS) at er-la-opioidrems.com. abuse, addiction, overdose and death.
• Emphasize Patient and Caregiver Under-
Therefore, the United States Food and Drug standing of the Medication Guide - Stress
Administration (FDA) has required a Risk Evaluation to patients and caregivers the importance of and Mitigation Strategy (REMS) for ER/LA opioid reading the Medication Guide they will receive analgesics. A REMS is a strategy to manage known, or from their pharmacist every time an ER/LA potential, serious risks associated with a drug product opioid is dispensed to them.
and is required by the FDA to ensure that the benefits • Consider Using Other Tools - In addition
of a drug outweigh its risks. The drug products subject to the Patient Counseling Document there to this REMS include all extended-release oral- are other publicly available tools to improve dosage forms containing hydromorphone, morphine, patient, household and community safety, as oxycodone, oxymorphone, or tapentadol; fentanyl and well as compliance with conditions of treatment, buprenorphine-containing transdermal delivery systems; including Patient-Prescriber Agreements and and methadone tablets and solutions that are indicated risk assessment instruments.
for use as analgesics.
To report all suspected adverse reactions The FDA and manufacturers of ER/LA opioids are associated with the use of ER/LA opioid analgesics developing Continuing Medical Education programs for contact the manufacturer of the specific product and/ or notify the FDA MedWatch program: 800-332-1088 or Under the conditions of this REMS, prescribers of ER/LA opioid analgesics are strongly encouraged to do To learn more about the ER/LA Opioid REMS all of the following: program, call 800-503-0784 or er-la-opioidrems.com. • Educate Yourself - Complete REMS-compliant
CME courses when they become available.
*See "Upcoming CME Programs" on back page • Counsel Your Patients - Discuss the safe
use, serious risks, storage and disposal of Investigational Drug Compounding
Drugs listed as "investigational" or
study. Physicians who are not part of an investigational "investigational new drug" (IND) by the United
study who are found on prescription audits to have Stated Food and Drug Administration (FDA) must
prescribed investigational-only drugs will be referred to be prescribed or ordered by a licensed prescriber
the Medical Board for appropriate action. who has a FDA-sanctioned IND for a recipient/
A pharmacy and/or pharmacist found to be patient who also is part of the IND study.
compounding and dispensing such prescriptions will (This statement does not apply to a FDA-approved be referred to the FDA enforcement office, in addition drug which is used for an unapproved indication.) to the Oklahoma Board of Pharmacy, for possible The FDA defines the term IND as meaning an unapproved drug or biological drug that may be used in FDA policy requires that for a patient to gain a clinical investigation study. The term may also include access to an investigational drug outside a clinical trial, a biological product that is used in vitro for diagnostic the patient must have a serious or immediately life- threatening disease or condition and no comparable The Medical Board may not consider a prescription or satisfactory therapeutic alternatives. Additionally,
for an "investigational only" drug ordered by a licensed the drug manufacturer and the patient's physician
practitioner to be a valid prescription unless the must make special arrangements to obtain the
physician is part of an investigational study for an drug for the patient. These arrangements must
"investigational only" drug and the patient for whom be authorized by the FDA. These safeguards are in
the prescription is written is part of the investigational place to avoid exposing patients to unnecessary risks. Medical Board Pioneers Use of QR Codes
Oklahoma State Board of Medical Licensure and address, telephone and office hours, hospital privileges, Supervision (Medical Board) is the first in the nation to insurance participation and board status. In the same incorporate QR (quick response) codes on the medical way that traditional UPC bar codes changed the way licenses of physicians and other medical professionals. we pay for groceries, the QR codes will allow for rapid QR codes are two-dimensional bar codes first designed check-in of medical professionals at training events, for the automotive industry in Japan. They can contain clinics, hospitals, etc. more information than a regular bar code and may be The QR code on medical licenses should provide read by devices many people already own, such as a real service during emergencies, according to Board smart phones and tablets. The ubiquitous black and Deputy Director Reji Varghese. white square box will now appear in the lower right hand "Law enforcement or emergency medical personnel corner of all newly issued or renewed physician licenses establishing an incident command system at the scene of an accident or emergency will Scanning the code will provide direct, instant access be able to immediately identify and to a physician's information page as it appears on the confirm that the Good Samaritan Board's website, www.okmedicalboard.org. Some of offering assistance is indeed a the data available includes the doctor's education, licensed medical doctor," he said.
medical specialty and board certification, office Treating Addicted Colleagues
an addict. If symptoms and clinical judgment seem to indicate addiction, that course of treatment must be It is against the law for Oklahoma physicians to pursued. Order a urinalysis and other appropriate drug prescribe, sell, administer, distribute, order or give screening tests. The treating physician should attempt "any drug legally classified as a controlled substance to learn if the colleague/patient is in a good recovery or recognized as an addictive or dangerous drug for mode, attends AA meetings, counseling sessions, etc. other than medically accepted therapeutic purposes." If possible, have a third party verify the recovery status. (Oklahoma Medical Practice Act 435: 10-7-4 [24].) It All this should be made a part of the colleague/patient's is also illegal, "except as otherwise permitted by law," medical record.
to prescribe, sell, administer, distribute, order or give Secondly, if the treating physician is certain that
"to a habitué or addict or any person previously drug the colleague/patient is doing well in documented, dependent, any drug legally classified as a controlled solid recovery and poses no "threat to the public" substance or recognized as an addictive or dangerous when practicing medicine, then the treating physician drug." (Oklahoma Medical Practice Act 435: 10-7-4 DOES NOT have any obligation to report the colleague [25]). Inappropriately prescribing Controlled Dangerous to the licensing board or any other entity. Doctor/ Substances (CDS) to patients known to be addicts is patient confidentiality remains in effect. Appropriately unprofessional conduct for which physicians, if found document in the chart the reason for treating with CDS guilty, may be disciplined, which can include the and informed consent. possibility of losing their medical licenses. Thirdly, if the treating physician knows the
colleague/patient is a substance abuser, a threat to the ".doctors face difficult, often uncomfortable,
public and not in a good recovery, the treating physician ethical decisions when the addicted patient is
has two options.
another physician or health professional."
A. The treating physician can counsel the In addition to the legal consequences, doctors face colleague/patient and provide information on the difficult, often uncomfortable, ethical decisions when programs available in Oklahoma to assist and advocate the addicted patient is another physician or health for health professionals with substance abuse issues. professional. When treating a member of the public The treating physician can encourage the colleague/ who is an addict, physicians may simply dismiss that patient to call the appropriate program and ask for an patient from their practices if the patient refuses to intervention and/or assessment to determine the current follow medical advice. Treating the addicted colleague status of substance use, abuse, or abstinence. ALL presents both an ethical and legal dilemma. Physicians THIS MAY BE DONE WITHOUT ANY NOTIFICATION cannot skirt their ethical responsibility to the public TO A LICENSING BOARD OR OTHER ENTITY, and their profession by simply refusing to treat a non- provided that the colleague/patient follows through compliant addicted colleague. with the process, agrees to and follows the program's What is a physician to do when treating another recommendations, including any required treatment health professional who may be an addict? and long-term recovery activities. All of the recovery First, when treating a colleague, DO NOT rule
programs will report to the appropriate licensing board out the diagnosis of addiction because of misdirected if the colleague/patient does not participate in the professional respect or courtesy. It is human nature assessment, treatment and recovery recommendations for a treating physician to presume a colleague/patient and process.
is being honest. That's not always the case under Programs available to Oklahoma health normal conditions and particularly when dealing with professionals are: Treating Addicted Colleagues
Oklahoma Health Professionals Program
(42) "Failure to inform the Board of a state of (OHPP) Robert Westcott, MD, 405-601-2536
physical or mental health of the licensee or any other (MD, DO, DDS,PA and DVM) health professional which constitutes or which the licensee suspects constitutes a threat to the public." Nursing Peer Assistance Program (NPAP)
Laura Clarkson, RN, 405-525-2277
(RN, NP, CNS, NMW, CRNA) (43) "Failure to report to the Board unprofessional conduct committed by another physician." Allied Professional Peer Assistance
Program (APPA)

In Oklahoma, the authorities are: Billy Stout, MD, 405-962-1450 Oklahoma Board of Medical Licensure and
(PT, RC, OT, AT, LD, RT, RE, AA, RA, PED, Supervision
405-962-1400, 1-800-381-4519, okmedicalboard.org Oklahoma Pharmacists Helping Pharmacists

Oklahoma State Board of Osteopathic Examiners
Kevin Rich, 1-800-260-7574 Ext. 5773 Oklahoma State Board of Pharmacy
405-521-3815, ok.gov/OSBP
B. If the treating physician knows that the colleague/patient is a substance abuser, a threat to Oklahoma Board of Nursing
the public and not in a good recovery mode and the colleague/patient REFUSES to contact the professional Oklahoma Bureau of Narcotics and Dangerous Drugs
assistance program, then the treating physician has a professional, legal and ethical obligation to the profession and the public to report the colleague/ Oklahoma Offices U.S. Drug Enforcement Agency
patient to the proper authorities under the Oklahoma Oklahoma City: 405-475-7500 Medical Practice Act, 435:10-7-4 (42,43), which states a Tulsa: 918-459-9600 physician can be cited for unprofessional conduct for: New Ban on Hydrocodone Refills Effective November 1st
Effective November 1, 2013, prescriptions for at a time). Documentation for partial fil s would any medication containing Hydrocodone may not be required in accordance with OAC 475:30-1-12. be refilled. This applies even if the prescription Hydrocodone combination medications are stil was written prior to November 1st. Transfers classified as a CIII product and may be phoned are considered to be a refil of a pre-existing in. Mid-level practitioners (nurse practitioners, prescription and are not al owed. Partial fil s physician assistants, etc.) may continue to would be permitted (i.e. a prescription is written prescribe Hydrocodone combination medications for 100 but the patient only wants to purchase 20 at this time.
Board CME Efforts Recognized
Upcoming CME Offerings
The Oklahoma Medical Board staff received Honorable Mention Best of the Boards Award at the national meeting of Safe Practical Pain Management for
Administrators in Medicine (AIM) for its ongoing public and Primary Care Physicians & ER/LA
licensee educational outreach initiative, "It Takes a Village…to Opioid REMS: Achieving Safe Use While
Put on a Great CME Program." Improving Patient Care September 20, 2013,
AIM Best of the Boards Awards recognize programs and 8 AM - 4:30 PM St. Luke's United Methodist Church, initiatives that demonstrate outstanding "best practices" or 222 NW 15th St, OKC. Registration $75 innovations. The Award allows state boards to share the benefit of their accomplishments with colleagues and receive 6.5 AMA PRA Category 1 Credits for entire conference. recognition for their hard work.
A Day With The Judges
The Oklahoma Board was recognized for its efforts to Pain Management, Telemedicine, EHR, Judicial ease the delivery and increase the frequency of educational System and Official Disability Guidelines programs through the use of both new technology and November 15, 2013, 8:30 AM – 4:15 PM traditional face-to-face CME programs. The Board also was Conference Center, INTEGRIS Baptist Medical Center, commended for its commitment to collaboration through 3300 NW Expressway, OKC Registration $125. strong partnerships with the Osteopathic Board, OU College of ht p:/ sssanbar.wix.com/baptist Medicine, Oklahoma State University College of Osteopathic 7 Hours CME Medicine, Oklahoma State Medical Association, Oklahoma Osteopathic Association and professional liability carriers. This publication, printed by Central Printing is issued by the Oklahoma State Board of Medical Licensure & Supervision as authorized by the Board. 11,800 copies have been prepared and distributed at a cost of $6000.00. Copies have been deposited with the Publications Clearinghouse of the Oklahoma Department of Libraries.
Issues & Answers Vol 20 Issue 02 Summer 2013

Source: http://www.okmedicalboard.org/download/696/Summer2013.pdf


Graefes Arch Clin Exp OphthalmolDOI 10.1007/s00417-012-2226-y Visual outcomes and complications following posterioriris-claw aphakic intraocular lens implantation combinedwith penetrating keratoplasty Johannes Gonnermann & Necip Torun &Matthias K. J. Klamann & Anna-Karina B. Maier &Christoph v. Sonnleithner & Antonia M. Joussen &Peter W. Rieck & Eckart Bertelmann Received: 21 August 2012 / Revised: 31 October 2012 / Accepted: 21 November 2012

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Dietary Supplement Containing Biologically Active Substances For Improved Immune Function William J. Hennen, Ph.D. Dr. William J. Hennen holds a Ph.D in Bio-organic chemistry. An accomplished researcher, professor and author, Dr Hennen hold more than 10 patents and has published over 30 research