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Sweeping Measure Addresses Prescription Pills

Oct 16, 2017
Originally published on October 15, 2017 6:31 pm

Doctors would be limited to prescribing seven days' worth of opioids for patients with acute pain and would have to check a statewide database before ordering most prescription pain medications, under a proposal filed Friday in the state House.

The 114-page bill, sponsored by House Commerce Chairman Jim Boyd, R-Bradenton, incorporates proposals put forward by Gov. Rick Scott aimed at curbing the opioid epidemic that has engulfed the state.

Scott's office issued a news release Friday announcing the filing of the measure, an indication of the importance of what will be one of the most-pressing issues for the Legislature during the session that begins in January.

“Families across our state are struggling with pain and loss inflicted by the national opioid epidemic and today I am proud that Senator Benacquisto and Representative Boyd are filing important legislation to help combat this terrible crisis,” Scott said in the release. Senate Rules Chairwoman Lizbeth Benacquisto, R-Fort Myers, is expected to file a companion measure to Boyd's bill.

The proposal (HB 21) would limit doctors to writing prescriptions for three days' worth of opioids, such as highly addictive oxycodone, unless the practitioner decides a seven-day prescription is “medically necessary to treat the patient's pain as an acute medical condition.”

For the week-long supply, physicians would have to document the patient's “acute medical condition and lack of alternative treatment options to justify deviation” from the three-day limit.

Some doctors, especially those who work in emergency rooms, have balked at a three-day limit and the requirement for documentation, which they say would take away time from patients.

Critics of a three-day limit also say that prescription-drug restrictions, while possibly stopping new patients from becoming addicted, won't do anything to address the growing number of overdoses on heroin and fentanyl, a deadly synthetic opioid often mixed with heroin.

“In the emergency department, we see four to five overdoses a day,” Aaron Wohl, an emergency doctor in Lee County, told the Senate Health Policy Committee this week. “They're not any using (prescription) medications. They're using fentanyl and heroin.”

The limits are grounded in research that shows patients who took powerful pain medications for the first time had a higher chance of developing dependencies with longer prescriptions.

For example, new patients with a three-day prescription have a 3 percent chance of becoming addicted, compared to patients with a 30-day prescription, who have a 30 percent chance.

But Scott and his administration have indicated that the governor is open to increasing the three-day limit.

“The goal is to have a conversation and get everybody involved so as we go through this legislative session we have a bill that passes that is going to work to deal with the crisis,” Scott told doctors at a Florida Medical Association opioid summit in Tampa last week, after speaking about the prescription restrictions.

Shortly after Scott spoke, John Bryant, assistant secretary for substance abuse and mental health at the Department of Children and Families, expanded on the governor's comments, saying Scott was offering an opportunity for doctors to “get it in a way that you think is something less than harsh.”

“We had this discussion in our shop and find that there are a lot of reasons … why three days may be more of a constraint than an aid at this point,” Bryant said.

The bill also includes a controversial component that would require doctors to look up patients on a prescription drug database, called the prescription drug monitoring program. The program has been aimed at keeping patients from getting multiple prescriptions for pain medications from different doctors.

Scott's push to expand the use of the program is a dramatic departure from where he stood when he took office in 2011.

Then, the governor called for a repeal of the database, known as the PDMP. He reversed his opposition to it as Attorney General Pam Bondi lobbied heavily for the program to curb prescription-drug abuse.

State law now requires pharmacists to check the database before they fill prescriptions for controlled substances, but doctors are not required to consult it.

Many doctors and other health-care providers complain that the system is slow, difficult to use and takes too much time.

Even the state's surgeon general admitted the database needs work.

“I have heard from many users that our current system is not that user-friendly,” Surgeon General Celeste Philip, who serves as secretary of the Florida Department of Health, told the doctors at last week's meeting.

Philip said the department is working on updating the system and the revamped program “will be a lot less work.”

Law enforcement officials such as Bondi and some treatment providers view the PDMP as a critical tool.

Mary Lynn Ulrey, a nurse practitioner and CEO of Tampa-based Drug Abuse Comprehensive Coordinating Office, called the plan released Friday “the beginning of the beginning.”

“I do think the problem is on multi-levels. If people can't get prescription drugs for pain management, they will turn to other drugs, like heroin. So it's a start,” Ulrey told The News Service of Florida in a telephone interview. “I am glad to see discussion around the bill. I'm hopeful that they're paying attention. They know it's a crisis. And they're trying to do something.”

The proposal would also require pharmacists to check photo identification of patients before handing over controlled substances. A Senate panel heard complaints this week about patients who use aliases as a way of avoiding being tracked in the PDMP.

The bill drew praise from Walton County Sheriff Michael Adkinson, the president of the Florida Sheriffs Association, who noted that Senate President Joe Negron, R-Stuart, and House Speaker Richard Corcoran, R-Land O' Lakes, were also quoted in Scott's news release Friday.

“I think that tells you that they understand what we're all dealing with here. It's that serious,” he said.