Doctors would be limited to ordering a maximum of seven days’ worth of potentially addictive medications for patients with acute pain and would have to consult a statewide database before writing the prescriptions, under a sweeping measure approved Tuesday by a key Senate committee.
The proposal (SB 8) includes many items requested by Gov. Rick Scott and is a top priority for legislative leaders as they attempt to curb Florida’s opioid epidemic.
“We all know the statistics. … Opioids are killing 16 people per day in Florida,” said Sen. Lizbeth Benacquisto, the bill’s sponsor.
While many of the state’s overdose deaths are caused by street drugs heroin and fentanyl, “many of those users’ journey started with an addiction to prescription medication,” Benacquisto said, adding that her proposal was crafted “in hopes we can stem the tide of addicts in the state.”
Under the measure approved unanimously Tuesday by the Senate Health Policy Committee, doctors would be restricted to writing prescriptions for three days’ worth of controlled substances, such as oxycodone, or a maximum of seven days’ worth of the drugs, if deemed “medically necessary.”
Doctors who prescribe the controlled substances would also have to complete a two-hour training course focused on the drugs.
And insurance companies would not be able to require “prior authorization” for medication-assisted therapy, which includes drugs aimed at weaning users off street drugs, such as heroin or fentanyl, or prescription drugs.
Benacquisto added the ban on prior authorization to a revamped version of the measure released Friday.
“When you have relapse rates that are as high with opioids, heroin and fentanyl, and you have someone who is willing to take treatment … and is asking for help, we should not stand in front of that. We should allow them to get immediately into a program to help them beat that addiction,” Benacquisto, R-Fort Myers, told reporters after the meeting.
Medication-assisted therapy has been shown to be successful in treating drug addicts, who have more than a 90 percent relapse rate, Benacquisto said.
The Senate bill includes $42 million for the Department of Children and Families to combat opioid and other substance abuse disorders. The money is to be spent on outpatient services; residential treatment; medication-assisted treatment, which involves the use of the drugs methadone, buprenorphine and naltrexone; peer recovery support; hospital and first-responder outreach; and services targeted to pregnant women.
The Senate plan also includes $6 million for substance-abuse treatment for people in the criminal justice system.
A House version (HB 21) of the proposal, approved by a committee last week, does not include the ban on prior authorization or the funding.
The Senate version approved Tuesday did not address concerns expressed by orthopedic and cardiac surgeons, who have told lawmakers that their patients need more than seven-day supplies of pain medications after undergoing what one orthopedist called “controlled demolition” on their bodies.
Surgeons must manage their patients’ pain, lobbyist Toni Large, who represents the Florida Orthopaedic Society, told the panel Tuesday. Seven days’ worth of drugs may not be enough to deal with the pain experienced by patients before and after surgery, according to Large.
“We’re put in a very strange medical, ethical and scientific dilemma,” she said.
Under the Senate and House proposals, patients would have to get additional prescriptions for pain medications from their doctors because refills for the Schedule 2 drugs cannot be called into pharmacies.
That’s problematic in a state where between 200,000 and 300,000 hip and knee replacement surgeries are performed annually, according to Brian Luskin, a Palm Beach County hand surgeon.
“It is almost infeasible for some of these people to get back to the clinic within the seven-day time frame,” he told a House panel last week.
Benacquisto said she is meeting with “stakeholders,” but appeared reluctant to move on the seven-day limit.
“It is a balance to strike to make sure that we’re focused on the best solution to the overall crisis and having a dialogue about sub-acute pain and the issues that folks who are dealing with those major surgeries are dealing with,” she said, adding that no one has brought her an amendment for consideration yet.
“I’ve looked at what other states have been doing, really trying to find a way to address the issue as best as we can, but I have not found that yet,” Benacquisto said.