If health care professionals prescribed appropriately, there would be no need for attorney generals from 17 states and the US Virgin Islands to ask pharmacy benefit managers (PBMs) to adopt measures designed to fight the epidemic. These measures include a 7-day limit on the supply of opioids dispensed for patients who are new to opioid therapy, a dosage limit, and requiring the use of immediate release opioids instead of extended release opioids.
Instead of asking PBMs to adopt these measures, maybe the AGs should be sending letters to Congress and or governors and state House and Senate leaders who have not yet adopted laws limiting dosage and number of day supplies. Last April, US Senators John McCain (R-Ariz) and Kirsten Gillibrand (D-NY) introduced bipartisan legislation that would limit the initial supply of opioids for acute pain to 7 days. The press release excerpts below succinctly outline the problem and solutions.
“One of the main causes for the alarming increase in drug overdoses in the United States is the over-prescription of highly addictive opioids, which have increased by 300 percent over the last 15 years,” said Senator McCain. “In fact, people who are addicted to prescription opioids are 40 times more likely to become addicted to heroin. In Arizona alone, heroin and opioid overdoses have skyrocketed, with the Arizona Department of Health Services reporting that more than 1,000 people required emergency room treatment for drug overdoses in 2014 while heroin-caused deaths increased by 44 percent between 2013 and 2014… on these deadly drugs.”
“Our bipartisan bill would target one of the root causes of the opioid addiction crisis, which is the over-prescription of these powerful and addictive drugs for acute pain,” said Senator Gillibrand. “Too many lives have been destroyed, too many families have been torn apart, and too many communities all over New York are suffering because of this tragic epidemic. I am proud to join with Senator McCain in this urgent fight against the over-prescription of opioids, and I look forward to seeing it pass through the Senate as quickly as possible.”
Under current federal law, a medical professional must receive a license from the Drug Enforcement Agency (DEA) in order to legally prescribe schedule II, III, or IV controlled substances. Prescribers must renew their every three years. This legislation would require medical professionals to certify, as part of their DEA registration, that they will not prescribe an opioid as an initial treatment for acute pain in an amount that exceeds a 7-day supply, and they may not provide a refill.
And remember US Surgeon General Vivek Murthy’s open letter to all physicians regarding opioid prescribing. In the letter, Murthy sets forth that since 1999 overdose deaths have quadrupled, and that there are enough opioids for every adult in America to have a bottle of pills. Interestingly, he said that the increase in opioids does not follow an increase in reported pain. Rather, the amount of pain reported has been relatively stable since 1999. In the letter, Surgeon General Murthy asks clinicians to take a pledge, which can be taken online, to screen patients for opioid use and provide them with evidence-based treatment, including the CDC’s opioid-prescribing guidelines. He said that years from now he wants to look back and see that in the face of a crisis that threatened the nation it was “our profession” that stepped up and led the way.
We at UR Nation agree with the statement in the AG’s letter sent to PBMs that the opioid epidemic is “the most pressing public health crisis our country faces.” We applaud the actions of entities like CVS, the first national retail chain to limit opioid prescriptions to a 7-day supply for certain conditions and hope every prescribing physician will read the surgeon general’s letter and take the pledge. For this crisis to come to an end, clinicians’ prescribing patterns must change.