PABLO — Last year, the Federal Government declared opioid addiction a public health emergency with reports that over 2.1 million Americans are addicted to the drug.
The statics are even dire in Native American communities. The Center for Disease Control reports that in 2017, Native Americans accounted for the highest opioid overdose death rates and the second highest heroine overdose death rates in comparison to other demographics in the United States.
Complicating the ability to address the issue is that the majority of painkillers in circulation began with a legal prescription signed by a physician. In order to curb the epidemic at its source, the Confederated Salish and Kootenai Tribal (CSKT) Council voted to adopt “Controlled Substance Utilization and Dispensing Limitation” policies for Tribal Health pharmacies on the Flathead Reservation.
The new policies’ primary function is adopting the Center for Disease Control’s (CDC) treatment for acute pain recommendations, which states: “Clinicians should prescribe no greater than the quantity needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient and more than seven days will rarely be needed.”
Beginning January, Tribal Health pharmacists are required to contact prescribing physicians for medical documentation on patients who receive prescriptions over the CDC limits. Rather than counting prescription dosages per pill, Tribal Health will adopt a new system based on the drugs’ milligram count.
University of Montana clinic assistant and clinical pharmacist for the Tribal Health Jessi Cahoon met with Tribal Council to discuss the new guidelines. “The longer patients are prescribed high level opiates for pain, it increases their risk of addiction,” she said. “Our goal is to make sure patients receive the treatment they need while lowering the risk of addiction.”
Unique cases and circumstances will be overseen by the Pharmacy and Therapeutics Committee, a team made up of medical experts, inducted as the ‘final authority’ on controlled substances at Tribal Health. Aside from meeting with patients and physicians, the committee will determine the best treatment for pain on a case-by-case basis.
Hot Springs Tribal Council representative Leonard Gray noted a newfound accountability. “These policies may require doctors to adjust their treatment recommendations,” he said. “Some may not like it and that’s OK. It will bring some accountability to the prescriptions being written. This is a step forward in protecting our people.”
Tribal Health pharmacies will also recognize Montana’s Prescription Drug Registry, which limits access for patients who have been identified to abuse controlled substances. “Not only do we recognize the registry we report individuals from our clinics and pharmacies,” Cahoon said. “The more cooperation there is between agencies the better grasp we can get on this issue.”
Aside from managing controlled substances, the policy outlines expansion of pain management resources. Tribal Health Director Teresa Wall-McDonald said the department secured funding for alternative treatment options. “Our primary goal is to make sure that we are treating the underlying health issue,” she said. “We are also looking into options to cover patients who are interested in alternative pain management options.”
News of the new prescription drug policies comes in wake of reports that the Tribal Health pharmacy in St. Ignatius is being fined $95,000 due to alleged violations discovered from a yearlong investigation conducted by the Drug Enforcement Administration (DEA). The Department of Justice issued a press release stating: “The DEA conducted the inspection after it learned that approximately 2,500 oxycodone pills had been stolen or unaccounted for from the Tribes’ pharmacy in St. Ignatius, on the Flathead Indian Reservation. During the investigation, the DEA discovered significant violations of the regulations, including failing to adequately track records of the controlled substances in the pharmacy and failing to report the missing oxycodone pills to the DEA.”
Oxycodone is an opioid narcotic used to treat moderate to severe pain. The drug is classified as a controlled substance, with a very high risk for dependence and addiction. The Addiction Center reports that Oxycodone is one of the most commonly abused prescription drugs.
The Confederated Salish and Kootenai Tribes have reportedly been compliant with the DEA investigation and the Tribal Health pharmacy will receive an annual evaluation for the next three-years to ensure its compliance with regulations. The evaluation will be certified with the DEA.