33 Goals and Objectives The basic goal of this strategy is simply to reduce the quantity of opioids prescribed for long-term pain management, following guidelines to limit the use of opioids for this purpose. Measurable objectives can be constructed along the lines of making a percentage decrease in the number of opioid prescriptions filled that are for longer than a specified time period. Theory of Change Reducing the number of long-term prescriptions will result in fewer people becoming addicted to opioids beyond pain management, thereby reducing the addiction rate and, in particular, overdoses resulting in death. Examples California has created a Statewide Opioid Safety (SOS) Workgroup under the auspices of the State Health Officer, focusing on promoting safe prescribing guidelines as a singular pillar of the prevention program. California issued guidelines for prescribing controlled substances for pain in 2014, and then adopted the 2016 prescribing guidelines issued by the Centers for Disease Control and Prevention (CDC). The California Department of Public Health has issued educational materials to promote and disseminate these guidelines throughout the state. The CDPH Director/State Health Officer, in partnership with the SOS Workgroup, developed and disseminated a health care provider resource letter in March 2017 offering encouragement and resources on best prescribing practices and assistance for patients who may need special medical guidance due to opioid addiction and substance use disorder treatment. Massachusetts enacted legislation that calls for these constraints on prescribing opioids: • Imposes a seven-day limit on prescribing opioids to a patient for the first time. • Mandates that prescribers check the Prescription Monitoring Program (PMP) every time a Schedule II or III narcotic is prescribed. • Allows patients to request a partially filled opioid prescription. • Instructs all prescribers to complete appropriate training in pain management and addiction, to be determined by boards of registration. • Prior to issuing an extended-release long-acting opioid in a non-abuse deterrent form for outpatient use for the first time, says a practitioner must evaluate the patient’s current condition, risk factors, history of substance use disorder, if any, and current medications; and must inform the patient and note in the patient’s medical record that the prescribed medication, in the prescriber’s medical opinion, is an appropriate course of treatment based on the patient’s medical need. • Directs the prescriber and patient to enter into a written pain management treatment agreement for prescriptions for extended-release, long-acting opioids. • Requires the Department of Public Health to establish a voluntary non-opioid directive form, indicating to all practitioners that an individual shall not be administered or offered a prescription or medication order for an opioid. • Establishes a benchmarking mechanism for prescribers. The Department of Public Health determines mean and median quantity and volume of prescriptions for opioids within categories of similar specialty or practice types. Prescribers who go beyond the mean or median will be sent a notice that they have exceeded the limit.47 Resources The CDC produced prescription drug guidelines related to opioids in 2016. The American Academy of Pain Medicine and its board of directors have researched and approved certain evidence- based clinical practice guidelines for treating pain patients. The Permanente Journal published the “Physician Guide to Appropriate Opioid Prescribing for Noncancer Pain” by Timothy Munzing, MD.