1. Brian Sandoval Governor
Richard Whitley, MS Director
Cody L Phinney, MPH Administrator
John DiMuro, DO, MBA Chief Medical Officer
Pain Clinics Oversight Paul Shubert Acting Chief, Bureau of Health Care Quality and Compliance
Prepared & Presented by:

2. Department of Health and Human Services
2014 CDC Data indicates:
78 Americans die every day from an opioid overdose
Opioid pain relievers are the driving factor in the increase in opioid overdose deaths
Prescription opioids sold in the U.S. nearly quadrupled since 1999
At least half of all opioid overdose deaths, involve a prescription opioid
Among heroin users, approximately 3 out of 4 report abusing prescription opioids prior to using heroin
Department of Health and Human Services

3. Department of Health and Human Services
NUMBER OF METHADONE CLINICS
Year
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
# of NTCs 2 5 6 7 8 9 11 13 14
Department of Health and Human Services

4. Pain Management Facilities In Nevada
4 of 39 currently permitted OPFs and 2 of 64 currently licensed ASCs, address pain syndrome
All other physician offices, physician clinics, most urgent care facilities, so called pain management clinics etc., have no oversight by health care facility regulators
Any MD, DO, NP, PA-C can write prescriptions for opiates, this means every medical practice could be a “pain clinic”
Department of Health and Human Services

5. What Are Other States Doing?
Review of information from 23 other states revealed 7 have decided to regulate pain clinics in some way (LA, WI, TX, FL, AL, TN, KY)
3 states regulate as health care facilities (LA, WI, FL)
4 states regulate by the professional licensing boards (TX, AL, TN, KY)
16 states responded indicating they do not regulate pain clinics (IL, MN, DE, MI, PE, CT, UT, IN, SC, NJ, NC, MO, AR, ID, VT, ND)
Department of Health and Human Services

6. Pain Clinic Definition
A pain clinic is any physician’s practice, clinic or facility primarily engaged in the diagnosis and treatment of chronic pain
Exclusions from this definition are facilities otherwise licensed or permitted under Chapter 449 of NRS/NAC
Included are individual prescribers of certain pharmaceuticals based on an established threshold
Department of Health and Human Services

7. Appropriate Oversight Agencies
Problem linked to physicians prescribing opioids
Problem linked to pharmacies and pharmacists dispensing opioids
Problem linked to health care facility medication diversion
Multifaceted approach
Department of Health and Human Services

8. Pain Clinic Regulations
Once a pain clinic/physician has met the threshold within the definition, there should be a specific set of regulations governing the practice including ongoing training requirements regarding opioid use/abuse and diversion
The training requirement should be for the medical professionals as well as other employees
Department of Health and Human Services

9. Department of Health and Human Services
Future Endeavors
Nevada needs to find ways to attract or qualify more physicians that are board-certified pain medicine providers
Nevada needs to encourage medical professionals to go low and slow when prescribing opioids and to treat the cause, not just the symptoms
Department of Health and Human Services

10. Department of Health and Human Services
Panel Discussion
Should we promote legislation to address the problem?
Is there consensus for defining pain clinics?
Is there consensus for pain clinics to register with the state?
Should training requirements be enacted for pain clinics?
What should the training include?
Department of Health and Human Services