A measure to ease the opioid crisis
A Maryland bill could encourage doctors to prescribe more cautiously.
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.