Doctors Wary Of Painkiller Prescription Limits
Surgeons complain it’s too restrictive for patients who undergo major heart surgery or hip replacement. Emergency room doctors gripe they don’t have the time or resources to comply. And pharmacists say it needs to be tweaked.
But the litany of suggestions offered by health care professionals over the past few weeks has done nothing to persuade key lawmakers to change a sweeping measure aimed at curbing opioid addiction and overdoses, now the leading accidental cause of death in the U.S.
The proposal (HB 21) continued moving forward Monday when it was unanimously approved by the House Appropriations Committee.
According to research, 80 percent of heroin users first abused prescription drugs, whether their own or someone else’s. Other studies show that a patient’s chances of addiction increase as the number of days a first prescription for opioids lengthens.
The data has spurred state lawmakers to focus not only on treating drug users but on trying to keep patients from getting hooked in the first place.
That involves restricting doctors to writing prescriptions for a three-day supply of opioids, such as OxyContin or Vicodin, for patients with acute pain, or a seven-day supply if physicians deem it “medically necessary.”
The Legislature also wants to force doctors to consult a statewide database, known as a prescription drug monitoring program, or PDMP, before writing prescriptions for controlled substances, something doctors have strenuously opposed in the past.
Pharmacists already are required to enter information about most controlled substances into the database, but only about 27 percent of Florida health care providers authorized to prescribe controlled substances are currently registered to use the PDMP, according to a November presentation by PDMP Director Rebecca Poston.
Lawmakers want doctors to use the database to ensure that patients aren’t “doctor shopping,” or seeking prescriptions for addictive drugs from multiple physicians. Patients who do so may be addicted, or could be selling the drugs on the street, in some instances to subsidize their habit.
Under the bill approved Monday by the House Appropriations Committee, doctors would have to consult the database before writing any prescriptions for controlled substances, including drugs that have a low potential for abuse.
Rep. Jim Boyd, the bill sponsor, told The News Service of Florida that the measure may undergo some minor changes before it hits the desk of Gov. Rick Scott, who has made stemming the opioid epidemic — which he declared a public health emergency last summer — one of his top legislative priorities.
“Will we end up with something at the end of the day that is a little bit of a compromise? Perhaps. But right now, we’re kind of sticking with the policy that we started with,” says Boyd, a Bradenton Republican whose district is experiencing some of the state’s worst impacts of the opioid scourge.
Doctors don’t want to have to look up every patient’s drug history in the database and don’t want to have to consult it before writing prescriptions for every kind of controlled substance. They also want the database to be linked to patients’ electronic health records, something also contained in the House plan. And doctors have repeatedly complained that the database is clunky and is frequently unavailable.
The House proposal includes about $873,000 to upgrade the drug database, something not included in a Senate companion measure, which, unlike the House version, also steers more than $53 million to substance abuse-related issues.
“We’re hopeful that the final bill will be a mixture of checking the PDMP for the appropriate medications in the appropriate instances, with a PDMP that is integrated into the EHR (electronic health records), so that it’s easy to do so and it’s not an undue burden on the physician,” Jeff Scott, Florida Medical Association general counsel, told the News Service on Monday.
While doctors and lawmakers might reach a deal on the use of the PDMP, prescription restrictions will likely remain a sticking point.
Hank Hutchinson, a Tallahassee orthopedic surgeon, told lawmakers that “putting a strict day limit on prescriptions for pain medication” is “really bad for my patients,” who he said travel from as far away as Dothan, Ala.
He also bridled at the wording of the exception to the three-day restriction that would allow doctors to order seven days’ worth of narcotics if they decide it’s “medically necessary.”
“I don’t think any of us as competent physicians would write a prescription that wasn’t medically necessary,” Hutchinson said. “Whatever day you choose to pick, I think it’s arbitrary. Patients are different. Their pain is different. And we treat them all differently.”
The bill would allow doctors to write additional prescriptions, with the same seven-day limit, if patients need more pain medication. But Hutchinson said that would impose a burden on patients who would have to travel sometimes for hours to get another prescription, and it would cost them another co-payment for the drugs.
“I think you’re really hurting the patients,” the surgeon said. “Whatever number you put on it, there’s going to be unintended consequences for the patient that I don’t think are good.”
While Boyd indicated a compromise about checking the drug database might be in the works, he seemed unlikely to budge on the prescription limit, something pushed by Scott and also included the Senate plan (SB 8).
“We’re sticking pretty hard and fast to the three- and seven-day prescription periods. They do have the ability to re-up that. … So, I think there’s a little bit of room already that they don’t realize,” he said.