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— BY MICHAEL ROIZEN, M.D., AND MEHMET OZ, M.D.

Q: In one of your columns, you said docs and pharmacists were sometimes overreacting to the Centers for Disease Control and Prevention recommendations for curbing prescription opioid abuse. What guidelines could help patients who need pain relief while also helping to curb the abuse of these medications? — Kate S., Streetsboro, Ohio

A: That’s the big question, and people in health care, public health and government are working hard to find an effective approach.

In your own state of Ohio there’s been important progress. There are new rules and guidelines drawn up by your state medical board, the Ohio Board of Nursing and the state dental board. These guidelines require physicians to talk to patients about surgical, physical and injection options for pain management, not just medications, before prescribing an opioid pain reliever.

If opioids are prescribed, the use of them is assessed in relation to specific safety checkpoints that focus on the dosage and the length of time for which the meds are prescribed. After a person has received an opioid Rx for six weeks, the doc will be required to reassess the patient’s condition. When the prescription reaches a specific dosage level, the patient must be referred to a pain management specialist. There’s even a provision for supplying patients on high-dose opioids with the overdose-prevention drug Naloxone.

Ohio is leading the nation in finding smart ways to manage these medications, in part because it leads the nation in opioid-related emergency room visits. In 2018, Dr. Mike’s Cleveland Clinic alone reported a total of 2,832 opioid-related emergency department visits, including 1,006 overdoses. The total cost in Ohio for opioid-related medical interventions runs close to $9 billion a year.

On a good note, Ohio has seen opioid prescriptions drop by 30 percent (nationally the drop is 19 percent), while doctor shopping has been nearly eliminated, in great part due to the Ohio Automated Rx Reporting System (OARRS). We believe OARRS and these new guidelines could become a national model, or a piece of one, that offers the quality care and protection every patient needs.

Q: I live in the country, and my dogs are out in the yard/fields every day. I just heard there are now 13 tick species in Minnesota. It’s tough to keep the dogs safe, and I worry they will spread tick-borne diseases to my kids and me! What’s the smart way to stay safe and still let the dogs enjoy the outdoors? — Madison Q., Duluth, Minnesota

A: You’re right to want to protect your family and your pets from ticks. The deer tick is the most common variety in your area (it carries Lyme disease), but there are other ticks that can cause illnesses such as babesiosis (a protozoan infection) and even Rocky Mountain spotted fever (spread by the American dog tick). For some areas, the newest threat may come from the Asian longhorned tick, first reported in the U.S. in 2017. Around the world, it’s “an important vector for human and animal disease,” according to a CDC report — although in the U.S. it has yet to be connected to transmission of any disease.

So, you want to keep ticks off your dogs. But the Food and Drug Administration has issued a warning about potential “neurologic adverse events” associated with flea and tick products in pill form that contain isoxazoline — although they did say that these anti-tick meds are safely used for the majority of dogs and cats. So, we say, if you can, “Avoid the I-socks!” Stick with flea and tick collars, and a thorough inspection of your dogs after every trip outdoors. (A trimmed short coat of fur also is helpful.)

Bottom line: Protect yourself and your pets. But skip the Scottish whisky called Sheep Dip, which legend has it was used to kill ticks and fleas on sheep before they went to market. This “legend” now sells for as much as $57 a liter — not cost effective. For now, stick with the new flea collars that last from eight weeks to eight months.

•••

(Mehmet Oz, M.D. is host of "The Dr. Oz Show," and Mike Roizen, M.D. is chief wellness officer and chair of Wellness Institute at Cleveland Clinic. Email your questions to Dr. Oz and Dr. Roizen at youdocsdaily(at sign)sharecare.com. Distributed by King Features Syndicate, Inc.)

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