Regulation of Opioids Increasing

Recently, the CDC published the first national standards for prescribing opioids, new standards specifically dedicated to confronting this crisis. This set of guidelines will provide much greater leverage going forward when interacting with non-compliant providers, much as evidence-based guidelines have afforded crucial controls for assuring patients receive appropriate care.

We are also starting to see some substantive legislative action in response to the opioid crisis that extends beyond formulary adjustments or drug reclassifications.

Massachusetts is the most recent state to limit opioid use, enacting legislation that limits prescriptions to a 7-day supply.  Massachusetts is among the nation’s worst states for heroin and opioid usage, with more than 100 drug fatalities each month.  Although the bill’s language grants providers the flexibility to prescribe outside the 7-day limit, it will force providers to document their reasons, and severely impede any provider from acting as a “pill mill” without legal repercussions.

Specifically, Massachusetts’ House Bill 4056, Section 19D states:

(a) When issuing a prescription for an opiate to an adult patient for outpatient use for the first time, a practitioner shall not issue a prescription for more than a 7-day supply. A practitioner shall not issue an opiate prescription to a minor for more than a 7-day supply at any time and shall discuss with the parent or guardian of the minor the risks associated with opiate and the reasons why the prescription is necessary.

(b) Notwithstanding subsection (a), if, in the professional medical judgment of a practitioner, more than a 7-day supply of an opiate is required to treat the adult or minor patient’s acute medical condition or is necessary for the treatment of chronic pain management, pain associated with a cancer diagnoses or for palliative care, then the practitioner may issue a prescription for the quantity needed to treat such acute medical condition, chronic pain, pain associated with a cancer diagnosis or pain experienced while the patient is in palliative care. The condition triggering the prescription of an opiate for more than a 7-day supply shall be documented in the patient’s medical record and the practitioner shall indicate that a non-opiate alternative was not appropriate to address the medical condition.

I think we will see more states follow suit with similar legislation, as new drug formularies and tighter opioid rules have already been proposed across the country. All of this movement will hopefully culminate in a new—and hopefully successful—phase in the nation’s battle against the ongoing opioid healthcare crisis.