Doctors: State’s new opioid law onerous
It applies to far more drugs, cuts time, funds
When Dr. Pamela Trout, a pediatrician and a solo practitioner in Orlando, heard about the state’s new opioid law, she didn’t worry because she rarely prescribes opioids.
But then she learned the law, which went into effect July 1, covers more than just opioids.
Almost all medications that are classified as Schedule II through V drugs, including steroids; anti-seizure medications; stimulants like Adderall, Ritalin and ADHD medications; Ambien and Xanax are included in the law.
The Controlled Substances law doesn’t put a limit on the prescription of non-opioid drugs.
But it adds a new requirement for doctors to check a statewide database when prescribing from a list of more than 100 scheduled drugs before putting a pen to the prescription pad.
And while many local doctors agree that the law is a step in the right direction to reduce the availability of opioids, they also find its mandates onerous
and time-consuming.
“The number of patients that I see that are on ADHD medications that I refill every day is crazy,” said Trout. “It is more regulation and more consequences for something that we already did pretty smoothly. It just adds to the work for the day, and I don’t think it’s necessary for my patients.”
Florida is now one of two dozen states to have passed legislation related to prescription of opioids. It’s part of a nationwide effort to curb the opioid epidemic that’s killing more than 115 people each day.
The laws vary from state to state. In Florida, it places a three- and seven-day limit on the prescription of opioids for acute pain. It also requires that health providers check the state’s prescription drug monitoring program before writing a new prescription for most controlled substances for patients who are 16 and older.
Called E-FORCSE, Florida’s prescription drug database was created by the Legislature in 2009 to encourage safer prescribing of controlled substances. The database collects and stores scheduled drug prescriptions, which are mainly dispensed by pharmacists. The database can help providers identify patients who are “doctor shopping.”
Under the new law, providers who fail to check the database can suffer penalties, including a disciplinary action against their licenses.
There’s still a lot of misinformation about the law among providers and patients.
Local health systems have launched massive education campaigns for their staff and patients about the new law, emphasizing mostly limitations on opioid prescriptions, to prepare the patients for what they should expect when they see their doctors.
On Aug. 6, the state Department of Health made live Take Control, an educational website to educate the public about the new law.
“The department is committed to working with patients and the health-care community to clear up any possible confusion about the new law to ensure that patients are able to obtain and fill necessary prescriptions for pain medication,” said Dr. Celeste Philip, State Surgeon General and Secretary, in a news release.
“I think it has had a bigger impact than any law that I can remember in recent years,” said Dr. Jennifer Keehbauch, chief medical officer of Winter Park Memorial Hospital. “It touches you wherever you practice and whatever your specialty is.”
Besides the new EFORCSE requirement, the law’s restrictions on opioid prescriptions have also raised concern among some physicians, particularly surgeons.
“I think the idea was good, but it went too far … for a person who has major surgery, the seven-day limit is totally inadequate,” said Dr. Larry Halperin, an orthopedic surgeon in Orlando. “It is yet another addition to our workload, forcing us to spend more of our office time looking down at the computer.”
Executives at Jewett Orthopaedic, a large practice in Central Florida with more than a dozen offices treating between 700 and 900 patients each day, say that the law’s restrictions create an inconvenience for patients after surgery and worry about the impact of patient requests for new prescriptions.
“If we have to renew prescriptions every three days, or even every seven days, you can imagine the workload,” said Jewett CEO Chad Wiggins.
More than a month after the law went into effect, Dr. Benjamin Kaplan, an internal medicine doctor in Orlando, calculated the financial cost of the legislation in his practice.
“If you include log-in time, and then checking the patient’s name, it takes about 30 seconds to 1 minute to check the database,” he said.
Kaplan said he spends 30 to 45 minutes a day on EFORCSE, which adds up to about a $750 loss because of the patients he can’t see.
“Then you can extrapolate out the rest of the loss for the year: five days a week; 48 weeks, taking into account vacation, per year ….” he said. “You should be very careful when prescribing opioids. I get it and I know that. But making a blanket statement affecting all physicians in the state of Florida, that’s a big deal without really knowing the true validity of that decision.”
Although studies have shown that opioid prescriptions have dropped in recent years, there’s little data to show that laws limiting opioid prescriptions have made an impact in curbing the current epidemic.
“The laws do serve to reduce opioid prescription, but the ultimate goal is to reduce overdose deaths and laws like HB21 are unlikely to do that,” said Dr. Joanna Starrels, associate professor of medicine at Albert Einstein College of Medicine.
While the prescription opioids are to blame for the onset of the epidemic, the main driver of overdose deaths today is illicit opioids, including heroin, fentanyl and the deadly carfentanyl, researchers say.
“I struggle to think of anywhere that opioid overdose deaths have been reduced,” said Starrels, whose research is focused on opioids and related practices and policies. “As we roll out well-intentioned initiatives to reduce the risks associated with prescription opioids, we need to keep the big picture in mind. Our ultimate goal needs to be to reduce opioid overdose deaths.”