Rules on opioids passed by panel

Extra steps aimed at curbing abuse

Regulations requiring extra steps for doctors who prescribe high doses of opioid pain medication cleared a final hurdle when they were approved by a legislative subcommittee Tuesday.

The approval by the Legislative Council’s Administrative Rules and Regulations Subcommittee came despite repeated complaints from patients who said the rules will force them to live with more pain.

“I just got to where I could hold down a job,” said Lindsey Black, 29, of Cabot, who said her doctor has already started reducing her dosage of pain medication in preparation for the new rules. “I just got to where I could take care of my daughter.”

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 are aimed at reducing the abuse of opioid medications such as hydrocodone, oxycodone and morphine.

Kevin O’Dwyer, an attorney for the Medical Board, said the rules don’t limit what doctors can prescribe, but simply outline steps doctors should already be taking.

“This is the road map for physicians to be able

to continue to treat their patients as they’ve been treating them in an effective, safe and appropriate way,” O’Dwyer said. “The perceived fear, I can’t really respond to that because a lot of it quite frankly is not a legitimate fear.”

The rules would require doctors to do such things as explore alternative treatments when prescribing daily doses 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 surgery, to

a seven-day supply.

The subcommittee initially approved the rules last month, but Sen. Terry Rice, R-Waldron, asked the Legislative Council to refer them back to the subcommittee.

On Tuesday, Rice, who said he has had two spinal surgeries and has taken medication for chronic pain, asked the subcommittee to refer the rules back to the Medical Board to provide more protections for chronic-pain patients.

“Regardless of what we say this rule will allow, the circumstances is [doctors] are cutting them all back,” he said. “Time is needed to find a balance of treatment and regulation.”

His motion died for lack of a second.

On a motion by Rep. Jeff Wardlaw, R-Hermitage, the subcommittee then approved the rules in a voice vote.

Because it is not meeting this month, the Legislative Council granted the subcommittee

the authority to give final approval to rules.

O’Dwyer said the rules will go into effect in about 10 days.

Although she’s not on the subcommittee, Sen. Linda Collins-Smith, R-Pocahantas, said she’s heard from patients across the state who are concerned that the rules will keep them from getting the medications they need.

“I think we’re trying to make sure that we don’t tighten the reins too tight so that doctors can’t treat their patients properly,” she said.

O’Dwyer told lawmakers that other factors have caused doctors to cut back on their prescriptions. For instance, the state’s Prescription Drug Monitoring Program in April sent doctors reports showing how their prescribing over the previous six months compared with that of their peers.

“Whatever grade you get on that report card, they don’t want it to be at the highest level,” he said.

Arkansas’ regulations on

prescriptions for chronic pain already required a patient’s doctor to have a contract with the patient setting requirements such as random drug screens or pill counts.

Act 820, passed by the Legislature last year, also requires doctors to check the Prescription Drug Monitoring Program’s database of prescriptions for painkillers and other frequently abused drugs before prescribing such a drug.

Act 820 also calls on the state boards that license doctors, pharmacists, nurses, dentists, optometrists and veterinarians to develop rules limiting the amount of opioids that can be prescribed or dispensed to patients.

According to the Federation of State Medical Boards, at least 24 other states have adopted laws or rules limiting prescriptions for acute pain since 2015. Most or all states also have rules on chronic-pain prescriptions, according to the group.