Hello, this is Dr. Amol Soin. I am a practicing pain management physician, member of the state medical board of Ohio,the pain management rep to medicare with the CAC, and am current President of the Ohio Society of Interventional Pain Physicians. I support HB 48 and am a strong proponent of the new abuse-deterrent opioids(ADOs) being introduced into the market. By making prescription painkillers much harder to abuse, we can give people in pain the treatment they need without contributing to the accidental or purposeful overdose problem.

The average abuser will crush a pill into powder and snort it, or melt and inject it. Many prefer the extended release form designed to be taken once or twice a day.

As you might imagine, a pill that can relieve significant pain for 12 to24 hours contains a lot of medication. When it's abused, the user gets the whole dose at once, producing a strong high. Abuse-deterrent opioids provide a significant barrier to this kind of tampering. They make the pills difficult to crush, or cause them to melt into a form that can't be injected.

The U.S. Food and Drug Administrationhas done a lot to encourage more ADOs to be brought to the market. When most of the prescribed opioids on the market are hard to abuse, we will have taken a significant step toward stemming the tide of pain pill addiction.

This is not to say that abuse-deterrent opioids are a panacea. A sophisticated chemist could probably still get around the deterrent properties. But for the average abuser, prescription pain pills with abuse-deterrent features are significantly harder to abuse, and data show this prevents overdose deaths. By preventing the immediate release of the whole dose, the deterrent mitigates the likelihood of an overdose.

Because tamper-resistant pills are more expensive than their counterparts, many insurance companies will not pay for them, even though they save lives.

This should change. StateReps. Robert Sprague, a Republican from Findlay, andNickie Antonio, a Democrat from Lakewood,have introduced House Bill 248, which prohibits health plans from denying coverage of ADOs based solely on cost. Of particular note, this bill includes the way Medicaid, the government health insurance program for low-income people, covers pain prescriptions.

I treat Medicaid patients and I can tell you that some of them are in this situation because they got hurt and lost their jobs. Their pain keeps them from working again, and their lack of income means they must rely on Medicaid for health insurance coverage.

In Ohio, Medicaid is provided through managed care providers that specify what medical providers a patient can see, what treatments he or she can have, and what medications are allowed. These are vulnerable people who deserve to have their pain managed appropriately. Doing so can substantially improve the quality of their lives, perhaps even allowing them to resume productive activities.

Every patient who takes a prescribed painkiller is at risk of becoming addicted to it, and society runs the risk of having that medication diverted into illegal use. Seventy percent of the opioid painkillers abused are taken from a relative or acquaintance.

We are not going to control the human factor in this equation – the temptation some people have to divert and abuse opioids. But now we can control the formulation of the pill itself, making it much less attractive to those who might want to abuse it. I commend lawmakers for promoting access to abuse-deterrent opioids. Their efforts will decrease abuse, reduce overdose deaths, and make legitimate pain treatment available without worry to patients who need it

Sincerely,

Amol Soin, M.D., MBA, ABIPP, FIPP, DABPM

Chairman, The Ohio Pain Clinic

Medical Director, Ohio Anesthesia Providers, LLC

Medical Director, Kettering Innovation Center

Medical Director, Pain and Regional Anesthesia-Greene Memorial Hospital

Clinical Assistant Professor of Surgery, Wright State University

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