States Reach for More Control Over Prescribing of Opioid Painkillers

States Reach for More Control Over Prescribing of Opioid Painkillers

Tired of waiting for federal action, a number of states are introducing legislation to control the prescribing of opioid painkillers, such as Vicodin, Percocet and OxyContin. Motivated by the soaring numbers of deaths from overdoses of prescription opioid painkillers and to a lesser extent heroin, state lawmakers are introducing, or at least considering new bills that limit how much opioid doctors in the state can prescribe per patient - how much opioid per pill, how many pills per prescription, and when the drugs can be prescribed at all. The latest example of such legislation comes from Massachusetts, where a bill has been passed that places severe restrictions on prescribing opioids to control pain. In Maine, a new bill has been introduced, and in Vermont, similar legislation is being considered. Vermont Governor Peter Shumlin said in an interview that states are taking their own initiatives because drug industry lobbyists have the ability to block federal initiatives. "The states are going to lead on this one because Big Pharma has too much power," Shumlin said.

Massachusetts leads the way

Massachusetts Gov. Charlie Baker was moved to tears during the signing ceremony at the Statehouse on March 14, 2016, in Boston, during his announcement of a new bill he called "the most comprehensive law in the nation to combat an opioid addiction scourge, including a seven-day limit on first-time prescriptions for opiate painkillers." According to an Associated Press report, the Republican governor became emotional while recalling the families he had met who had lost loved ones to the "deadly, merciless epidemic" of opioid abuse and tragic deaths from opioids. The new law goes beyond limiting prescribing of opioid painkillers, and requires that people treated for overdoses in hospital emergency rooms undergo an evaluation within 24 hours and be given treatment options before discharged. The new law also requires school districts to establish substance abuse prevention policies, and to perform interviews with students to assess their "risk of addiction." The new bill also establishes advanced training programs for health care providers and law enforcement. "This is the first law in the nation to limit an opioid prescription and I hope other states consider pursuing something similar," Baker said.

Maine may the most limiting so far

Massachusetts might be the first, but it may not be the most restrictive. In Maine, where the same concern for opioid overdose deaths is driving lawmakers, new legislation has been introduced that will:

  • Limit prescribing of opioid painkillers for acute pain to three days and chronic pain to 15 days
  • Cap prescriptions at 100 morphine milligram equivalents per day (the potency of morphine is used as the reference point for other opioids)
  • Require doctors to check the Prescription Monitoring Program before prescribing opioids to see if patients have received similar prescriptions elsewhere
  • Require doctors to undergo mandatory training before they can prescribe opioids.
(Source: Bangor Daily News) Impressed by federal statistics that say 75 percent of new heroin users first become addicted to prescription opioids, Maine lawmakers believe that by reducing the flow of prescription drugs now, they will reduce both prescription opioid and heroin deaths downstream.

Doing the "right thing"

Tom Clark, clearinghouse manager for the Prescription Drug Monitoring Program Center of Excellence at Brandeis University, told the Portland Press-Herald that Maine's proposed bill would be among the strictest in the nation if it is passed. "This is quite a signal," Clark said. "Maine is doing the right thing. This tells me they're very serious about changing prescribing practices. It's a very progressive proposal." Currently, 27 states require doctors to use the state's prescription monitoring program before prescribing of opioid painkillers, but Clark said in some states the requirements are weak and there are many loopholes. And surveys have shown that many physicians notoriously avoid checking their state prescription monitoring databases because it's "too time consuming." Dr. Christopher Pezzullo, chief health officer for the Maine Department of Health and Human Services, said experts across the country have been consulted, and the bill was in preparation for months, to come up with a proposal that would make "a significant dent in opioid prescriptions." "If these measures had only been in place 10 years ago, I doubt we would have seen a heroin abuse crisis of today's magnitude," Pezzullo said.

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