Opioid dosage rules delayed

The Arkansas Legislative Council voted Friday to refer back to a subcommittee for further review the state Medical Board’s regulations affecting doctors who prescribe high doses of opioids.

In a divided voice vote, state lawmakers approved a motion by Sen. Terry Rice, R-Waldron, to send the regulations back to the Legislative Council’s Administrative Rules and Regulations Subcommittee. The rules cleared the subcommittee on Tuesday, over the objections of chronic-pain patients whose prescriptions for such medications have been reduced.

“While we have an opioid epidemic, I am going to ask for some more time on this to … try to avoid some of the unintended consequences,” Rice told lawmakers on Friday.

But Sen. Jonathan Dismang, R-Searcy, countered that the Medical Board’s rules are in response to action by the Legislature. Dismang had wanted the Legislative Council to sign

off on the rules on Friday.

“I think overprescribing is an issue,” he said.

Approved by the Medical Board in April, the rules are based on recommendations by the U.S. Centers for Disease Control and Prevention and are 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, or 10 five-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 taken effect, chronic-pain patients have said that doctors already are prescribing reduced dosages of pain medications.

“The unintended consequences of what this rule is doing is there are some lawyers telling these pain practitioners, ‘You got to get out of it,’ because they are scared of the Medical Board,” Rice said. He said he isn’t criticizing the Medical Board.

“Some doctors are telling them [patients] to go to the medical clinic and tell them you are an addict and they will give you methadone,” he said. “Some of them are refusing to do it and [they] say, ‘I am not not an addict and I don’t want to do that and the balance of somewhere over 50 milligrams is working for me with the methadone and the other opioid.’

“Not everybody is going to be an opioid junkie. Not every doctor is prescribing three years’ worth of medicine in six months. But we are putting it out there like they are,” Rice said.

Dismang said, “If someone is in a pain management therapy-type situation, they are allowed to prescribe those higher limits, higher doses, more frequent doses, so long as they are documented.

“I think that documentation is critical as we try to kind of rein this issue in,” he said.

Rep. Deborah Ferguson, D-West Memphis, said she is concerned that some doctors misunderstand the rule.

“It isn’t a hard 50 [milligram] limit. If you go to that amount, you need to explain why you are giving it to the patient and do a pain contract, which is basically the policy of the Medical Board for a long time,” she said.

Although the rules have not taken effect, chronic-pain patients have said that doctors already are prescribing reduced dosages of pain medications.