By Jason Poquette, BPharm, R.Ph
From a legislative perspective, no one could accuse Massachusetts of ignoring the growing opioid addiction and overdose epidemic. Now, in the latest effort, Governor Baker signed into law several new measures to try and stem the tide of this growing problem. Deaths due to opioid overdose (drugs such as oxycodone and hydrocodone) have been climbing for years in our state. Nearly 1,100 confirmed opioid overdose deaths occurred in 2014, up 63% since 2012. The data for 2015 was tracking for yet another sad increase.
The new legislation has been boldly described as “the most comprehensive measure in the country to combat opioid addiction.”
Previous legislative efforts have focused heavily on pharmacies. For example, a Massachusetts law passed last year in September requires all pharmacies to distribute with each narcotic prescription in schedule II or III a “pamphlet” designed to educate the public about the dangers of narcotic misuse and abuse, as well as providing contact information for addition resources in the state.
The new laws which went into effect Monday March 14 are aimed more directly at prescribers, and to some degree at the public, though the rules certainly involve the pharmacy as well.
First, the new law requires that a doctor limit the initial prescription of an opioid for an adult patient to a 7-day supply. Federal law and state law allow narcotic opioid prescriptions to ordinarily be written for up to 30 days – but this new law seeks to reduce that initial exposure. Sometimes a patient will have a bad reaction or simply not need a large 30-day supply of an opioid. The result is that the unused portion of the prescription could potentially get stolen or taken by someone other than the person it was prescribed for. Extra, unused pills that are not needed to manage pain leave open the door for recreational use of these powerful drugs.
Practically speaking, a “7-day limit” would mean that a prescription for oxycodone would be limited to 42 tablets initially, if prescribed to be taken 1 tablet every 4 hours (i.e. up to 6 per day).
Second, the new law allows patients to request LESS than the prescribed amount of any opioid prescription if they choose to do so (also referred to as a “partial fill”). Previously the pharmacist could only decrease the amount of an opioid prescription after consultation with a prescriber. The new law allows the patient to request a reduced amount without the need for the pharmacy to consult with the prescriber first. The pharmacy must, however, notify the prescriber of such occurrences within 7 days. Also, patients should know that when they choose to fill a lesser quantity they forfeit the right to fill the balance. Schedule II opioid prescriptions cannot be filled more than once.
The new laws also include other significant changes including required counseling in the emergency room for suspected opioid addiction and the wording of actual opioid prescriptions themselves. Additionally, doctors will soon be required to check the state PMP (prescription monitoring program) system to ensure their patients are not receiving opioids from other prescribers. Pharmacies frequently do this now, but the new law will require physicians to do it also.
Of course, the $64,000 question is whether these laws will actually reduce opioid overdoses and addiction. That’s a great question. I’m afraid I don’t have the answer, since these laws are not only new, but untested. Let’s say I’m hopeful, if not confident. And I am glad that our politicians have at least shown the courage to try.