Friday, March 2, 2018

Florida House approves bill that would limit opioid prescriptions to three day supplies

Posted By on Fri, Mar 2, 2018 at 11:40 AM

click to enlarge PHOTO BY DENNIS YIP
  • Photo by Dennis Yip

While the sponsor acknowledged the bill won’t solve the state’s problem with opioid abuse, the House on Thursday unanimously passed a measure that includes imposing prescription limits.

“I don’t think it (the problem) is going to completely go away, but I think this is a way for us to fight back,” Rep. Jim Boyd, R-Bradenton, said Thursday as he finished presenting his bill (HB 21) to the House.

The bill, in part, would limit opioid prescriptions to three-day supplies, though seven-day supplies would be allowed if deemed medically necessary by physicians. The restrictions wouldn’t apply to patients suffering pain related to cancer, terminal illness, palliative care or serious traumatic injuries.

The goal is to help prevent people from getting hooked on prescription opioids, which can lead to turning to street drugs such as heroin and fentanyl.

Physician groups have had concerns with the bill and the prescription limits.

Rep Julio Gonzalez, a Venice Republican who is an orthopedic surgeon, warned Thursday that the limitations would be too restrictive for some patients and that 10 days may be more appropriate for people who have had major surgery or who have suffered major trauma.

But Boyd told the stories of two people he knows who underwent surgery. One person had complete knee reconstruction and walked out of the facility with a walker hours later. He had a follow-up four days later, Boyd said.

Another friend of Boyd was treated for a heart-valve replacement and an aneurysm repair. Boyd said his friend took Tylenol for three days in the interim between being released and a follow-up visit.

In both instances, Boyd said, the men were given 90-day prescriptions for opioids to relieve the pain.

“We are not trying to be doctors,” Boyd said, addressing Gonzalez’s criticism. “We are not trying to tell doctors how to do what they do, because they are the professionals. But I think there’s a little bit of work that needs to be done communicating, that with this horrible problem, we need to take dramatic steps to try to fix it.”

Opioid addiction and overdoses are now the leading accidental cause of death in the U.S. According to research, 80 percent of heroin users first abused prescription drugs, whether their own drugs or someone else’s supply. 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.

To ensure that patients aren’t “doctor shopping,” or seeking prescriptions for addictive drugs from multiple physicians, the bill also would require physicians to consult a statewide database before prescribing or dispensing controlled substances, something many physicians have been loath to do. Only about 27 percent of Florida health care providers authorized to prescribe controlled substances currently use the database, known as the prescription drug monitoring program.

The bill includes accommodations if the database is down or if there are electrical or technical issues. But in such instances, physicians would be required to document information in patient medical records and would be limited to prescribing three-day supplies or less of pain relievers.

The bill also would authorize the Department of Health to share and exchange database information with other states and would authorize the database to interface with electronic health systems used by health-care practitioners and facilities.

Lawmakers have directed about $1 million for improvements to the prescription drug monitoring program, but Rep. Gayle Harrell, R-Stuart, worried that the funding may not be enough to ensure that the database properly interfaces with electronic health systems used by physicians.

Harrell, who is married to a physician, said she shared Gonzalez’s concerns that the restrictions may go too far.

“I think the 10 days seems much more reasonable,” she said.

A Senate version of the bill (SB 8) is ready to be heard by the full Senate.

But the House and Senate bills have differences. Among other things, the Senate bill would not allow exclusions from the prescription restrictions for cancer patients, trauma patients and the terminally ill.

Boyd, who will leave the House this fall because of term limits, said the bill would help in the fight against opioid abuse but said he knows it won’t fix the problem.

“I’ll be gone next year but I hope that others of you will take up the fight and take the next steps to fight this problem, because I don’t think it’s going to completely go away,” he said.

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