A mea­sure to ease the opi­oid cri­sis

A Mary­land bill could en­cour­age doc­tors to pre­scribe more cau­tiously.

The Washington Post Sunday - - SUNDAY OPINION -

OPI­OID ABUSE and ad­dic­tion con­tinue to rav­age the United States — and its next-door neigh­bor, Canada, where there were four over­dose deaths per day in Bri­tish Columbia dur­ing Novem­ber. Closer to home in Mary­land, these ex­tremely ad­dic­tive drugs con­tinue to cause havoc. Heroin killed 918 peo­ple in the state through the first nine months of 2016, up from 534 in the same pe­riod of 2015.

Gov. Larry Ho­gan (R) ad­dressed the cri­sis in a set of leg­isla­tive pro­pos­als on Jan. 24, the most in­ter­est­ing of which was a plan to limit the du­ra­tion of first-time opi­oid pre­scrip­tions to seven days each, sub­ject to re­newal — with ex­cep­tions to that limit for can­cer-re­lated pain, ter­mi­nal ill­ness or the treat­ment of a sub­stance-re­lated dis­or­der. (Some chem­i­cally sim­i­lar med­i­ca­tions are com­monly used in ad­dic­tion pro­grams.) Al­though the re­la­tion­ship of this mea­sure to fight­ing heroin abuse may not be im­me­di­ately ap­par­ent, it is real: Many heroin ad­dicts turn to that il­licit drug af­ter first get­ting hooked on pre­scrip­tion painkillers. To the ex­tent that author­i­ties can curb ill-ad­vised or un­nec­es­sary pre­scrip­tion of opi­oids, they may, over time, suc­ceed in eas­ing the wider drug epi­demic.

In that sense, Mr. Ho­gan’s pro­posal is con­sis­tent with pre­scrib­ing guide­lines is­sued na­tion­ally by the Cen­ters for Disease Con­trol and Pre­ven­tion last year. The CDC guide­lines re­minded doc­tors that opi­oids are not “first-line or rou­tine ther­apy” for chronic non-can­cer pain and that they should be is­sued in low dosages and small amounts, af­ter non-opi­oid al­ter­na­tives have been tried. The guide­lines specif­i­cally ad­vised that pre­scrip­tions last­ing three days or less would of­ten suf­fice for acute pain and that “more than seven days will rarely be needed.” Cur­rently, doc­tors and den­tists of­ten write for much longer than that.

Will it make a dif­fer­ence? That’s for the Gen­eral As­sem­bly to de­bate, and, to be sure, there isn’t much ex­pe­ri­ence to draw on since the CDC guide­lines are so new. Still, Mr. Ho­gan’s pro­posal tracks with mea­sures adopted in the past year by other states, no­tably Mas­sachusetts, whose state med­i­cal so­ci­ety deemed the law not an un­due bur­den on physi­cian au­ton­omy but “help­ful” and coun­seled its mem­bers on how to com­ply. Cer­tainly, the change Mr. Ho­gan pro­poses could at least en­cour­age doc­tors to treat opi­oid pre­scrip­tion with even more cau­tion than they al­ready do. A legally bind­ing stan­dard, in fact, of­fers them a strong ar­gu­ment with which to re­sist the some­times sub­tle pres­sure — so­cial, com­mer­cial or oth­er­wise — to pre­scribe more.

Mary­lan­ders are dy­ing by the hun­dreds in this epi­demic. Thou­sands more — 41 per­cent of the state pop­u­la­tion, ac­cord­ing to a new Gon­za­les Poll — have been af­fected in some less dras­tic but un­doubt­edly heart­break­ing way. What­ever else they take into ac­count while weigh­ing Mr. Ho­gan’s bill, law­mak­ers must never lose sight of that aw­ful toll.

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