2018 State Legislative Conference October 25 - 27 Ft. Lauderdale, FL

1. Christina Cavanagh, MD, FAAFP
FAFP Chair Government Relations

3. Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2013 and 2014

5. Long story short, Governor Scott used the opioid crisis as means to an
end – pass “the most stringent opioid legislation” as leverage in bid for
U.S. Senate.
 HB 21/SB 8 was created, “Controlled Substances”
 HB 21 was written by the governor’s staff with no input from medicine,
medical societies or otherwise.
 Legislators were unwilling to amend for fear of political retribution on
their bills.
 Signed into law March 19, 2018 by Governor Scott

6.  Aimed at reducing opioid deaths and addiction in Florida.
 Restricts Schedule II controlled opioids for acute pain to a 3-day supply
but allows physicians to prescribe up to a 7-day supply in certain
situations.
 Acute pain is defined as the “normal, predicted, physiological, and
time-limited response to an adverse chemical, thermal, or mechanical
stimulus associated with surgery, trauma, or acute illness.”
 Includes exemptions from the prescription limits for cancer patients,
people who are terminally ill and those who are receiving palliative
care. Trauma patients who meet certain criteria for severity of injuries
also would be exempt from the limits.

7.  Required physicians to consult the Prescription Drug Monitoring
Program (PDMP) prior to prescribing or dispensing a controlled
substance starting on the bill’s implementation date of July 1, 2018.
Unfortunately, the PDMP requirement did not include a sufficient
appropriation for EHR interoperability.
 Requires every practitioner registered with the U.S. Drug Enforcement
Administration and authorized to prescribe controlled substances to
take a two-hour continuing education course. The FAFP was one of
only four organizations initially approved to provide the CME credit in
both live and online courses. Only “statewide physician associations
allowed.” However, BoM is now opening up education providers to
avoid anti-trust concerns.

8.  Too soon to really tell, but the focus still remains ensuring patients get
appropriate treatment/relief for acute pain.
 Lesson learned, never turn your back on the politics – or prepare to
suffer the consequences.
 Hopefully once the elections are over, a more reasonable approach
which includes full collaboration with the FAFP and organized medicine
in Florida will resume.
 Amendments in 2019 being investigated, including PDMP
interoperability appropriation, clarification on schedule III/IV/V
limitations, and longer durations – although unlikely in this political and
public relations environment.

9. Pain Management and Opioid Safety
• Family physicians find themselves at the crux of the issue, balancing care of people who
have chronic pain with the challenges of managing opioid misuse and abuse
• One-in-ten (9%) IAFP physicians believe the prescription drug abuse crisis is the number
one Public Health crisis facing Illinois, while the majority (53%) say it is a “very serious”
problem among the top public health issues we face.
• IAFP is a leader with the Illinois Prescription Monitoring Program (ILPMP); 98% of
respondents to the IAFP member survey are registered with the IL PMP. IAFP physicians
in rural areas are more likely to write prescriptions for opioids at least daily (60%) than
those in mid-size cities (30%) or in Chicago (23%).

10. Naloxone
In October of 2017, the Illinois Department of Public Health (IDPH)
issued a standing State Order to make the overdose reversal drug
Naloxone (Narcan) available to first responders and members of
communities across Illinois without a prescription.
IDPH offers a variety of resources, including a list of FAQs, on their
website http://dph.illinois.gov/naloxone

11. Illinois’ Prescription Monitoring
Program (PMP)
The State of Illinois Opioid Action Plan

12. Illinois’ Prescription Monitoring
Program (PMP) Strategies
Increase PMP Use by Providers
• Ideally, the PMP will be fully integrated into electronic medical records (EMRs), but it is recognized that
it is difficult to mandate integration as not all systems are completely electronic. One possibility is to
provide the state integration module for free and target larger hospital systems first.
• State law requires health system EMRs to integrate the PMP into EMR by 2021. Currently, the PMP is
integrated in 35 systems and will be integrated into another 51 systems soon.
• Give delegates and non-traditional prescribers (RNs, PAs, CNPs, ME/Coroners) access to the PMP. The
PMP is working on expanding delegate access (including to coroners). Currently it is designed for up to
3 delegates designated by a provider. This will likely be amended as many prescribers work in different
systems with different potential designees every day. PMP is working on a better option for delegate
access while still protecting patient information.

13. Illinois’ Prescription Monitoring
Program (PMP) Strategies
Reduce high-risk opioid prescribing through provider education and guidelines
• Identify providers statewide who are prescribing opioids outside of CDC
guidelines (>90 MMEs/daily). IL PMP will share information on risk mitigation
tools, prescribing guidelines, CME and academic detailing.
• Require training on opioid prescribing as part of controlled substance (CS)
licensing and require that prescribers be registered with the PMP as part of CS
licensing. A total of three hours of CS continuing education must be taken in the
pre-renewal period.

14. State Adopts Prescribing Guidelines
On July 6, 2018, the Illinois Department of Financial and Professional
Regulation adopted the opioid prescribing guidelines of the Federation
of State Medical Boards as the guidelines for Illinois prescribers. More
information will be available as how this will effect guidelines that
health systems and medical groups have already adopted

15. Key Points for Practice
• Physicians should provide patient-centered care, including
coordinating with other disciplines, to patients with chronic pain
or dependence on opioids.
• Practices should encourage their physicians to use medication-
assisted treatment options for patients with opioid dependence.
• Physicians are encouraged to use their state prescription drug
monitoring programs for tracking purposes, to identify abuse or
diversion, and recognize persons who might be at risk.
• Methadone, buprenorphine, and naltrexone are used as opioid
substitutes in medication-assisted treatment.
From the AFP Editors

16. IAFP provides a Safe Prescriber program http://www.iafp.com/safe-rxt
to give our members the tools to manage this complex topic in their
practices as part of their comprehensive care to patients in a medical
home.

17. IAFP Opioid Safety Project
• IAFP received a grant from Telligen (the Medicare QIO) which will provide
assistance to SIU Health Care and SIH Medical Group in developing their
opioid safety policies and procedures. The IAFP Opioid Safety Workgroup (a
part of the Public Health Committee) will serve as expert advisors.
• Primary care physicians and clinical staff will receive education through the
IAFP Safe Prescriber Program. Additionally, the project will organize a
collaborative group for family physicians who provide Medication Assisted
Treatment in central and southern Illinois.
• IAFP has partnered with the SIU Center for Rural Health and Social Service
Development, the IL PMP, and AAFP’s HealthLandscape on this project.

18. Opioid Legislation Proliferated!
• SB 3023 was signed into law and was supported in coordination with a
contingent of around 40 other diverse interest groups. The legislation would
offer immunity from civil liabilities when using antidotes in cases of opioid
overdoses.
• HB 4707 was signed into law and created the Prescription Drug Task Force Act.
• SB 336 was signed into law easing restrictions on medical marijuana so it can
be used more widely as an alternative to opioids for pain management. The
law allows someone with a qualifying condition to access medical cannabis
while their application is being reviewed. Applicants also no longer need to be
fingerprinted or undergo criminal background checks.

19. Real World
Excerpt from Family Medicine Action Network:
Q1: What are the greatest challenges that family physicians, like you, face when addressing patients with either acute or chronic pain?
Julita McPherson – Chicago, IL
Patients with chronic pain are sadly being lost in the mix. They are struggling, and they are feeling a crunch between science, health,
and policy. Patients with low risk for substance use issues previously able to maintain functionality with their opioids for pain are being made
to feel "like criminals." Limited evidence on the management of chronic pain mixed with impractical and bureaucratic red tape with
insurance companies haunt family physicians who seek to help those struggling with pain. At a time where science is being
threatened and policies that have negative consequences, elevating adverse childhood experiences (ACE) for those struggling most,
thereby increasing the risk for chronic pain, chronic disease, and substance misuse, we feel backed into a corner fighting for our patients.

20. Activities Undertaken
Continuance of an Opioid Safety workgroup within our Public Health
Committee, whose members are leaders in opioid safety in their
medical group or health system.
• We call on this group to advise other family physicians who contact us with
questions.
• They also serve as advisors in the Illinois AFP project with SIU Health and SIH
medical group in central and southern Illinois.

21. Illinois Opioid Crisis Response Advisory Council
• Vince Keenan, CAE, IAFP EVP along with Elizabeth Salisbury-Afshar,
MD, MPH serve on this Advisory Council and its Prescribing Practices
Committee
• Advise the Illinois DPH and Illinois DFPR about emergency rules for
implementing SB336 – to use medical cannabis as an alternative to
opioids for pain management.
• Advise about using the Federation of State Medical Licensing Boards
opioid prescribing guidelines as the “rules of the road” for Illinois
prescribers. FSMB guidelines conflict with some current opioid
prescribing guidelines that health systems and medical groups
use. How do we reconcile this? How do medical malpractice
insurance carriers interpret these differences?

22. Next Steps
• Late November 2018
• opioids/pain management webinar
• updated Safe Prescriber module
• We hope to grow an MAT Member Interest Group (MIG) to link family
physicians doing MAT across the state to share best practices and
challenges.

23. Thank You!
Illinois Academy of Family Physicians
https://www.iafp.com/