On July 1st the state of Florida enacted the HB 21 bill to help fight Florida’s Opioid crisis. Dr. Ramos has become the local expert on the details and changes surrounding this bill. Click on the links below to read communication from Dr. Ramos on this topic.

Florida’s House Health and Human Services Committee unanimously passed the CS/CS/HB 21: Controlled Substances Bill. The bill focused on combating the state’s opioid epidemic – and it starts with us, the physicians.

 

The Ramos Center has actively lobbied over a decade to fight against this opioid epidemic, alongside local and state law enforcement, government and non-profit organizations, and is already operating under the regulations that the state bill will put into place – and has been for decades.

 

As you have heard from me in the past, I am proud of the fact that the Ramos Center is one of the largest and most effective Pain Medicine practices within the state of Florida over the past 19 years. We have the best overall patient outcomes, with a “last resort” mentality for opioid initiation, allowing us to report an industry-low number of patients who are prescribed opioids.  In fact, it’s merely a fraction of the total – 1,800 out of 10,000+ (18%).  Additionally, 96% of our patients are insured – this contrasts opioid-only clinics which have a cash-based model; only 1% are under 30 years old;  71% are older than 50 years old; 82% of our patients are treated with non-opioid alternatives, such as a comprehensive range of cutting edge technology, interventional modalities, physical therapy and behavioral management;  100% of all new patients are carefully screened via physician review, a mental health evaluation, an analysis of PDMP (FL Prescription Drug Monitoring Program (E-FORCSE), and a bi-annual drug testing.

 

Because we hold ourselves to higher standards of patient responsibility, we have earned a spot as one of the most referred to practices in the state. This humbles and motivates us to continue our responsible approach to chronic pain patients, as well as being committed to the same level of responsibility to our community. When prescribing opioids, we take the necessary measures to limit the frequency and dosage for patient safety by focusing on interventional procedures.

 

By firmly believing in patient and physician education and exhibiting responsible prescribing – the Ramos Center has grown to be one of the highest regarded, reliable, and trusted sources in the community in terms of treating and managing chronic pain. Due to the sheer volume of recurring chronic patients that we manage, even with our low 18% prescription rate, a large volume of paper prescriptions is administered with the strictest standards and compliance.  Patients, community and prescriptions are safer when their needs are processed by us.

 

With this, I am happy to share an update from Manatee County Sheriff Wells that in the last 6 months of 2017, there was a 75% decrease in overdoses and deaths, and an 85% decrease thus far in 2018. I’m hopeful that we, healthcare providers, will be more educated and equipped to responsibly treat our patients, and ensure a healthier, happier future for all involved.

 

Since the NEW Florida Bill on Opioids (HB 21) was enacted on July 1st, 2018, the Ramos Center has remained your primary source of knowledge regarding current and best practice models in opioid management. I personally commit to organizing and executing local seminars to help educate the physician population, as well as the residents within our community about the new legislation.


I am thankful to the network of physicians who support and refer to our practice, and I truly believe that together, we are one step closer to emerging from the decades of opioid abuse. Our growth is a direct result of your referrals, and for that our team is extremely grateful. As always, I encourage you to reach out to us at any time with further questions or concerns you may have regarding our specialty, practice, shared and future patients. We look forward to continuing our professional relationship with you and serving your patients who suffer from chronic pain.

What Does This Mean For Our Patients

We are following the recommendations that are accepted by the American Society of Interventional Pain Physicians (ASIPP) and the CDC for prescribing opioid medications for chronic pain.  Patients receiving opioids from us can expect to see the following steps from our office as well as across the United States.

 

The element of responsible management of controlled substances by physicians relates to MME (Morphine Milligram Equivalent). This will affect those suffering from both acute and chronic pain. The effective milligram dosages should be targeted at a lower reasonable dose; another necessary step in proactively managing the risk of instances of addiction and/or overdose.

 

Some patients have been referred to us with a high dose of medications that have been prescribed by others and we have been decreasing.  You can expect continuation of the weaning down process with utilization of our Opioid Behavioral Program.  This may require monthly follow up appointments as well as additional testing and assessments.  Even though the percentage of high dose patients in our practice is very low; we will be bringing this percentage down.  Which also means, that most of our moderate dose patients will decrease to be low dose.  The goal of every treatment plan is to improve function and reduce pain for our patients.

 

  • Will these new requirements be easy to implement? No.
  • Will this new legislation be convenient for doctors and patients alike? No.
  • Will the new legislation save lives? Yes.

 

Opioids are a LAST RESORT

The State of Florida is taking steps to curb the opioid epidemic and urge a conservative approach to pain management that focuses on other modalities and interventional procedures. Prescribing opioids are the last resort. For example, in a practice like the Ramos Center it is only when deemed absolutely necessary, such as a patient who is diagnosed with intractable pain that opioid medications will be prescribed.  Opioids are the last in the algorithm to treat chronic pain following activity modification, lifestyle changes (weight loss, smoking cessation, etc.), interventional therapy and even after advanced interventional therapy.

 

Legislation Information

Recent legislation aimed at tackling Florida’s continuing opioid problem once again puts the focus on the epidemic that ravages our population. The Ramos Center has set a good example of this during the last 18 years and will continue to comply to changes.  When the new Florida Bill on Opioids (HB 21) is enacted on July 1, 2018, as planned, we expect an even greater decrease in opioid-related consequences.

 

There are three NEW main components which will be imposed in the Opioid Bill (HB 21):

 

  1. Opioid prescriptions written to treat acute pain will be limited to a three- to seven-day dose. Note that there has been a request made to amend this regulation to extend maximum dosage to ten days.
  2. Mandatory physician review of the E-FORCSE (Electronic Florida Online Reporting of Controlled Substances Evaluation) database to determine a patient’s current prescribed medications prior to writing new prescriptions for controlled substances.
  3. 3. Authorized physicians are required to complete a board-approved, two-hour continuing education course on prescribing controlled substances.

 

 

It is important to understand the difference between acute and chronic pain. Acute pain will subside. Chronic pain is ongoing and often debilitating. One may experience acute pain after a dental procedure, minor injury or surgery. With the new proposed legislation, those suffering from acute pain will be limited to only a three-, seven-, or ten-day opioid prescription. Prescriptions for chronic pain should be limited and preferably temporary. Intractable pain requiring long term opioid therapy should rely on extended released medication and lower dosages.