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A big problem for medical professionals is what to do when a patient suffering from pain is dealing with or appears to be dealing with an opioid addiction. Denying the medication that could ease the pain seems unreasonable, but feeding the addiction could be even worse.

The Pennsylvania Department of Health, in an effort to help doctors and nurses in the state make decisions in such circumstances, on Wednesday released a set of guidelines designed to help in the selection of alternate pain management strategies. The voluntary guidelines were crafted by the state’s Safe and Effective Prescribing Task Force, a group assembled to help address the state’s prevalence of opioid addiction.

“Tragically, the opioid epidemic has made addiction prevalent in our everyday lives,” Jen Smith, secretary of the state’s Department of Drug and Alcohol Programs, said at a news conference Wednesday afternoon. “We live in a time where the number of individuals suffering from this disease is the highest it's ever been. … If we're going to continue to make strides against opioids, we must give physicians the tools to adequately treat individuals in their active addiction and equally as important in their recovery.”

Among the alternative treatments that are offered in the new guidelines are physical therapy, acupuncture, osteopathic or chiropractic treatment, non-opioid medications and mindfulness-based therapies. Dr. Rachel Levine, secretary of Pennsylvania’s Department of Health, also talked about steps that medical professionals can take to identify patients who might be suffering from addiction so that they know when to turn to alternatives to opioids.

“Really, all patients that are brought to the acute care center, an acute care hospitals should be screened for an opioid use disorder,” Levine said. “This screening represents a perfect time to begin the potential proper diagnosis and treatment with those suffering from the disease of addiction, the disease of opioid use disorder.”

The alternative pain management strategies in the guidelines are divided between patients with chronic pain, cancer-related pain and acute pain.

Levine, Smith and other speakers at Wednesday’s news conference emphasized that the guidelines were voluntary, saying that it was essential for primary care physicians to make decisions with patients and not be bound by too many state regulations. Dr. Jon Shapiro, representing the Pennsylvania Medical Society, said that his organization supported that tactic.

“The voluntary guidelines that we're discussing today are intended to help health care professionals provide patient outcomes to supplement, but not replace the individual provider's judgment,” he said. “So the Pennsylvania Medical Society believes these guidelines should remain voluntary and not mandated in statute or regulation. Each individual patient represents a requirement for a thorough evaluation and a treatment plan.”

The Wolf administration’s moves Wednesday stand in contrast to the governor’s decision last year to veto a bill that would have introduced a formulary for drug prescriptions for injured workers receiving treatment under workers’ compensation. The intent of that bill was also to help doctors make decisions to combat opioid addiction, using a formulary like those commonly seen in private health insurance plans.

Wolf, after vetoing Senate Bill 936 in April 2018, followed up by announcing the creation of the Safe and Effective Prescribing Task Force. The advocacy organization Commonwealth Partners argued that the veto was tied to Wolf’s relationship to a firm that specializes in workers’ compensation cases, Pond-Lehocky – a firm that had also donated, indirectly, to Wolf’s re-election campaign.

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