Ending an epidemic

New laws affect DO opioid prescribing practices in Arizona and Mississippi

Learn how recent opioid legislation might impact physicians’ prescribing abilities.

Ashley Altus
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As the nation’s opioid epidemic shows little sign of abating, the AOA is actively monitoring and responding to any new legislation that has the potential to impact how osteopathic physicians address the pain needs of their patients.

Arizona and Mississippi recently introduced new legislation intended to crack down on opioid overuse.

The AOA supports a variety of approaches to addressing controlled substance misuse, abuse and diversion while trying to ensure that patients with legitimate pain care needs are able to access timely care.

“We urge a flexible, evidence-based approach that allows physicians to utilize their independent medical judgment to determine appropriate treatment,” says Raine Richards, JD, AOA director of state government affairs.

Here is a look at the new legislation and what it could mean for physicians practicing in those states and for the effort to curb the opioid crisis in the U.S.

Arizona 

Arizona Governor Doug Ducey pushed a bill through the Arizona legislature that caps initial opioid prescriptions at 5 days (14 for post-surgical patients) and 90-milligram morphine equivalents per day, subject to limited exceptions. If patients require a higher dose, they must consult with a pain specialist.

According to the Arizona Department of Health Services, the state had 6,749  possible opioid overdoses reported from June 15, 2017, to March 22, 2018. Forty percent of individuals were prescribed opioids two months prior to their overdose.

Michael Dekker, DO, director of addiction psychiatry for the Southwest Network, a nonprofit organization that provides behavioral health services to patients in Arizona’s Maricopa County, recently testified about the opioid crisis to the Arizona legislature.

“We want to prevent opioid dependency and still allow people to get treatment for their pain,” Dr. Dekker says. “This legislation is definitely going to make physicians think twice before prescribing opioids.”

A lack of providers in Arizona

Treatment centers and addiction medicine providers are scarce in Arizona. According to research from Pew Charitable Trusts, there are about 20 providers per 1,000 adults with substance abuse problems  in Arizona. The national average is 32 providers per 1,000 adults with substance abuse problems.

One reason Dr. Dekker believes there is a shortage of providers in his state is because of the lack of addiction fellowships. Of the 104 addiction medicine and addiction psychiatry fellowships in the U.S., none train fellows in Arizona.

“Where physicians train, they usually stay there. Without an addiction fellowship here, there are not going to be a lot of treatment options,” Dr. Dekker says.

Mississippi

Mississippi also updated regulations that affect a physician’s ability to prescribe opioids. The AOA commented on the Mississippi Prescription Monitoring Program (MPMP) regulations, which would increase the number of physician practices defined as a “pain management practice,” subject to additional administrative requirements.

The regulations would require physicians to query the MPMP every time a controlled substance is prescribed and require additional CME. As written, the regulations also failed to appropriately recognize all pain-related subspecialty certifications offered by the AOA.

According to the CDC, Mississippi had the fourth highest opioid prescribing rates in the country in 2016.

Guidelines for chronic opioid use

The AOA also commented on the Federation of State Medical Boards’ Draft Report of the Workgroup on Prescription Drug Monitoring Programs, in support of a tailored, evidence-based approach to increase administrative requirements placed on physicians.  This would avoid placing undue burdens on physicians and impede their ability to deliver timely, appropriate care.

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6 comments

  1. Angie

    Since many of the overdose problems are related to illegal/counterfeit pills, I’m not sure this will help the problem. It will probably exacerbate the problem for a time because it provides greater desire and thus opportunity for counterfeit pain pills. Thanks

    Reply

  2. Linda Olds

    I agree with the comment from Angie. The new laws have decreased the number of opiate prescriptions; they consider this to be a success. However, where prescriptions are decreased, overdose deaths are increased.
    The result of the laws is to make things worse, though I’m sure that wasn’t the intention.
    Addicts are overdosing even more, and pain patients are going without the pain medication needed for them to function. Please reverse these laws!

    Reply

  3. Larry

    This law is just making more people turn to heroin and meth. while the people who really need the opiates are suffering.

    Reply

    1. Jill Strecker

      Yes I agree with you. The death rate is now higher because of ileagel use + 30%of veterans that have been lowered or taken off have committed suaside thank you For Ducie

      Reply

  4. Mellisse W. Brydges

    Doug Ducey is not properly informed. He sees only the damages caused from illegal drug use and perhaps a few bad pain doctors that would rather prescribe than study each patient’s real need for pain meds. If doctors are over prescribing medication and their patients have become addicts, the doctor should be sanctioned, not the patient. Ducey passed a bill that makes no sense and it is onerous to anyone who takes a small amount of opiates., eg 7.5/325 hydrocod/acetam per day. Now patients must pay a copay for their visit every month to a pain specialist whereas before this new law, the primary physician issued the script with no co-pay. Primary Care physicians are not drug dealers and neither are 95% of the doctors practicing. The other 5% or less are the ones causing the problems. Women in their 70’s do not all of a sudden become drug addicts when they start taking a small amount of pain meds. And further, Doctors certainly know more about the effects of pain medication than the Governor.

    Reply

  5. Larry

    I just got news that yet another person in our community committed suicide because his pain medicine was cut to such a low level that it did not control his pain. That makes 3 in this community. But just as bad many others have turned to meth, five that I know of. That is 8 families that has been destroyed. Please do something about this madness. People that were taking opiates should have been able to keep there doses.
    And pain clinics are a joke. They are just in it for the money and could care less about the patient. A nurse sees you and the Doctor is out on the golf course. They will see you 3 or 4 times and order many tests: X-Rays, MRI, CT– before telling you they won’t prescribe any more pain medicine than what your regular Doctor can write under this new law. It is crazy.
    Please do something.

    Reply

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