The Florida legislature is considering legislation that would limit opioid prescriptions for acute pain to a three-day supply, or seven days if a physician deems it medically necessary. Bills including that stipulation were filed in October by Gov. Rick Scott, along with Sen. Lizbeth Benacquisto and Jim Boyd, Republicans who represent southwest Florida.
The bill also provides for continuing education for medical professionals who prescribe opioid painkillers and treatment, and requires participation in the state’s Prescription Drug Monitoring Program (PDMP) by all health care professionals who prescribe opiates. The legislation would make it mandatory for every prescriber or dispenser to consult the state’s PDMP and review a patient’s prescription history before issuing a prescription for a controlled substance.
Scott’s bill would also provide $50 million in funding for drug treatment programs.
In 2016 there were 5,725 opioid-related overdose deaths in Florida, a 35 percent increase from 2015.
While the bills are supported by a drug manufacturers’ trade group, they are facing opposition from some physicians, who are concerned that the limits would hamper their ability to treat chronic pain.
Palm Beach County hand surgeon Bradon Luskin, M.D. told a state Senate committee recently that even a seven-day supply of opioids often might not be sufficient for patients after undergoing major surgery. “It’s just not reasonable for somebody who’s incapacitated to have to come back every three to seven days,” Luskin told the Senate Health Policy committee.
Benacquisto said legislators are considering the complaints raised by physicians. But she said the issue is “a balancing act” because statistics show people are more likely to become addicted the longer they’re on prescription opioids.
“I am going to be very careful about how we move forward with any adjustment to dosage timelines,” Benacquisto said.
A representative for cardiac and neurosurgeons also testified at the House and Senate hearings, echoing Luskin’s comments about a seven-day supply of pain pills being inadequate for some surgery patients. “I think the issue of post-surgical care is certainly a reasonable question and there are several ways that can be addressed,” said Senate Health Policy Committee Chair Dana Young.
At a meeting of the President’s Commission on Combating Drug Addiction, Pharmaceutical Research and Manufacturers of America (PhRMA) CEO Stephen J. Ubl said “the worsening opioid epidemic demands additional solutions, with new protections for patients.
“Too often, individuals receive a 30-day supply of opioid medicines for minor treatments or short-term pain. Over-prescribing and dispensing can lead to patients taking opioids longer than necessary or to excess pills falling into the wrong hands,” Ubl said. “Appropriate script limits, when combined with improved prescriber education and better coverage of treatment alternatives, can help ensure proper prescribing and reduce the risk of abuse. Given the scope and scale of this crisis, we believe this is the right thing to do.”
PhRMA has proposed a compromise that would exempt certain patients from the opioid prescription limit: those in hospice care, patients fighting cancer or other chronic diseases, and medication assisted treatments for patients seeking long-term addiction recovery, as long as they receive counseling and mental health support.
Ubl said PhRMA is working with the National Institutes of Health and the Food and Drug Administration to expedite the research and development of new non-opioid, non-addictive pain medicines.
Jill Gran, legislative affairs director for the Florida Alcoholism and Drug Abuse Association and Florida Behavioral Health Association, said the groups have not taken a position on the prescription limitation. “However, we do promote the use of physician screening for dependence among physicians who may be receiving opioids,” she told The Influence. “We also promote enhanced education for physicians.”