Fla. doctors wary of proposed painkiller prescription rules
Bill proposes 7-day limit for opioids if medically necessary.
TALLAHASSEE — Surgeons complain it’s too restrictive for patients who undergo major heart surgery or hip replacement. Emergency room doctors gripe they don’t have the time or resources to comply. And pharmacists say it needs to be tweaked.
But the litany of suggestions offered by health care professionals over the past few weeks has done nothing to persuade key lawmakers to change a sweeping measure aimed at curbing opioid addiction and overdoses, now the leading accidental cause of death in the U.S.
The proposal (HB 21) continued moving forward Monday when it was unanimously approved by the House Appropriations Committee.
According to research, 80 percent of heroin users first abused prescription drugs, whether their own or someone else’s. Other studies show that a patient’s chances of addiction increase as the number of days a first prescription for opioids lengthens.
The data have spurred state lawmakers to focus not only on treating drug users but on trying to keep patients from getting hooked in the first place.
That involves restricting doctors to writing prescriptions for a three-day supply of opioids, such as OxyContin or Vicodin, for patients with acute pain, or a seven-day supply if physicians deem it “medically necessary.”
The Legislature also wants to force doctors to consult a statewide database, known as a prescription drug monitoring program, or PDMP, before writing prescriptions for controlled substances, something doctors have strenuously opposed.
Pharmacists are required to enter information about most controlled substances into the database, but only about 27 percent of Florida health care providers authorized to prescribe controlled substances are registered to use the PDMP, according to a November presentation by PDMP Director Rebecca Poston.
Lawmakers want doctors to use the database to ensure that patients aren’t “doctor shopping,” or seeking prescriptions for addictive drugs from multiple physicians.
Patients who do so may be addicted, or could be selling the drugs on the street, in some instances to subsidize their habit.
Under the bill approved Monday by the House Appropriations Committee, doctors would have to consult the database before writing any prescriptions for controlled substances, including drugs that have a low potential for abuse.
Rep. Jim Boyd, the bill sponsor, said the measure may undergo some minor changes before it hits the desk of Gov. Rick Scott, who has made stemming the opioid epidemic —- which he declared a public health emergency last summer —one of his top legislative priorities.
“Will we end up with something at the end of the day that is a little bit of a compromise? Perhaps. But right now, we’re kind of sticking with the policy that we started with,” said Boyd, a Bradenton Republican whose district is experiencing some of the state’s worst effects of the opioid scourge.
Doctors don’t want to have to look up every patient’s drug history in the database and don’t want to have to consult it before writing prescriptions for every kind of controlled substance.
They also want the database to be linked to patients’ electronic health records, something also contained in the House plan. And doctors have repeatedly complained that the database is clunky and is frequently unavailable.
The House proposal includes about $873,000 to upgrade the drug database, something not included in a Senate companion measure, which, unlike the House version, also steers more than $53 million to substance abuse-related issues.