Ducey plan limits first opioid fills to 5 days
Legislative, policy steps part of fight vs. addiction
Arizona would limit all initial opioid prescriptions to five days for new patients under sweeping guidelines recommended Wednesday by Gov. Doug Ducey’s administration.
The plan also would limit maximum doses for pain medication, implement steps to taper down pain medications and require pain prescriptions to be filed electronically, rather than on paper, to limit diversion of drugs.
Those are among several recommended legislative and policy steps proposed by the Arizona Department of Health Services in an opioid action plan unveiled Wednesday.
The state aims to reduce opioid-
related deaths, increase awareness, address prescribing and dispensing of drugs, reduce illicit acquisition and diversion of opioids, and improve access to treatment.
Dr. Cara Christ, director of ADHS, said that the state recommended the five-day limit for initial opioid fills after reviewing other states’ restrictions and Centers for Disease Control and Prevention research.
She noted the Ducey signed an executive order last year that limited initial opioid fills to seven days for Arizona adults insured by Medicaid or the state’s health-insurance plan. However, CDC research suggested people face greater risk of long-term opioid use when they have at least six days of medication.
“Most people only need three days after an acute injury or surgery,” Christ said.
The five-day limit would apply to initial prescriptions for “opioid naive” people who have never taken pain pills or have not been on pain medication for months or years. It would apply to people covered by all types of insurance plans and self-pay patients, not only people on the state insurance plan or Medicaid whose initial pill fills are limited to one week under the governor’s 2016 order.
The report recommends a dozen legislative and policy changes, including legislation that would forbid prescribers from dispensing opioids and require pharmacists to check a statewide database to ensure patients aren’t prescribed both opioids and benzodiazepines such as Zanax or Valium — a potentially deadly combination.
Other recommendations include requiring doctors to complete three hours of opioid-related education, mandating different packaging and labeling of opioids and bolstering oversight of painmanagement clinics to target so-called “pill mills” that prescribe pain pills regardless of medical need.
The report also recommends legislation that would permit bystanders to call 911 for a potential overdose without fear of prosecution.
The ADHS report stems from Ducey’s June order that declared a publichealth emergency, which seeks to counter an epidemic that has claimed more than two Arizonans every day from opioid overdoses.
Ducey’s June order required hospitals, doctors and other health providers to more frequently update state health officials on overdose deaths and opioidrelated encounters.
Dr. Stephen Borowsky, a pain medicine physician who served on a committee that helped develop the state’s plan, said the recommendations are necessary to counter an epidemic created by years of lax prescribing and aggressive drug-industry marketing.
“We were fooled years ago to think that we could easily prescribe (opioids) for non-cancer patients,” said Borowsky, also a professor at University of Arizona College of Medicine-Phoenix. “Then the truth came out that that’s not the case. This has led to overprescribing.”
Borowsky said that doctors and the medical community have become more aware of the dangers of overprescribing.
For example, UA College of Medicine teaches opioid prescribing to third-year medical students as they begin their clinical rotations. Doctors and other prescribers such as nurse practitioners and physician assistants would be required to completed three hours of medical education on opioids.
In addition to policy changes, Arizona has stepped up enforcement with both the Arizona Medical Board sanctioning doctors over improper opioid prescribing and Attorney General Mark Brnovich’s civil lawsuit last week against Chandler-based Insys Therapeutics.
More than a half dozen former Insys Therapeutics executives face federal criminal charges over the company’s marketing of a fentanyl spray that is about 50 times more powerful that heroin.
While the report recommends tightened oversight of prescribing, Borowsky said it’s important to realize that many patients function well on opioids. The key is to find the right mix of responsible prescribing while ensuring people get people proper help.
“Because the medical community has caused the problem, along with pharmaceutical companies, the pendulum has swung the other way,” Borowsky said. “There are patients out there who qualify for opiates and are doing well. There’s a place for it.”