Panel backs rules on opioid dosages

Chronic-pain patients raise concerns

Regulations affecting doctors who prescribe high doses of opioids cleared a legislative subcommittee on Tuesday over the objections of chronic-pain patients whose prescriptions for such medications have been reduced.

Approved by the Arkansas State Medical Board in April, the rules are based on recommendations by the U.S. Centers for Disease Control and Prevention and aimed at reducing the abuse of opioid medications such as hydrocodone, oxycodone and morphine.

The rules would require doctors to take certain steps, such as exploring alternative treatments, when they prescribe a daily dose of more than 50 morphine milligram equivalents, equal to about 10 5-milligram tablets of hydrocodone, for chronic pain.

The rules also say doctors should avoid increasing a patient’s dosage to above 90 morphine milligram equivalents per day and “carefully justify a decision” for such a high dosage when it is prescribed.

The rules also would limit opioid prescriptions for acute pain, such as after a surgery, to a seven-day supply.

Although the rules have not yet taken effect, chronic-pain patients say doctors already are reducing the dosages of pain medications they prescribe.

Lisa O’Cain, 49, who lives near Morrilton and takes medication for neck and head pain, said some patients will turn to heroin and other illegal drugs to help manage their pain.

“I am managing” with a reduced dosage, O’Cain told the Legislative Council’s Administrative Rules and Regulations Subcommittee. “It’s not good like it was before, but I’m maintaining and that’s why I’m here.”

Sen. Terry Rice, R-Waldron, who said he has experience being on medication for severe, chronic pain, said he was concerned about the effect the regulations will have on such patients.

“In the Legislature, we tend to over-legislate a problem,” he said.

Kevin O’Dwyer, an attorney for the Medical Board, said the rules don’t establish any hard limits on dosages but simply add requirements.

“This doesn’t prevent any physician in the state of Arkansas from doing what they were doing, so long as what they were doing was the correct practice of medicine,” he said.

With Rice objecting, Rep. Kim Hammer, R-Benton and a co-chairman of the subcommittee, declared the rules reviewed and approved.

The rules will go to the Legislative Council for final approval on Friday.