HPPA 518 Health Policy Brief Assignment
To: Elizabeth Crowley
From: Jinjin Lin
Date: January 18, 2018
Re: Federal Restriction on opioid prescribing for pain management
Statement of Issue:
The addiction and abuse to opioids and other prescription pain relievers is a serious problem that affects the health and economic welfare of Americans. It is estimated that there are 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers and there are 91 Americans die every day from an opioid overdose. The total number of opioid pain relievers prescribed in the United States has dramatically increased in the past 25 years. In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills. This great availability of prescribed opioid should take the major liability by increasing the negative consequences related to opioid addition and abuse. Without the restriction of prescription, people can get opioid easier which may lead to opioid dependence and abuse.
- Drug overdose is a leading cause of accidental death in the US, with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers.
- The use of prescription opioids can have a lot side effects, even when they are taken as directed, such as physical dependence, increased sensitivity to pain, constipation, nausea, vomiting, dry mouth, sleepiness, dizziness, and confusion, and depression.
- In economic view, prescription opioid abuse is costly. It is estimated that the nonmedical use of opioid pain relievers costs insurance companies up to $72.5 billion every year.
- Repeatedly long term opioid drugs use tends to induce tolerance. Tolerance occurs when the person is no longer responding to the drug as strongly as he or she did at first, thus he or she needs to increase the dosage in order to achieve the same effect.
Policy Options
- A federal restriction initial supply limit on prescribing opioid for acute pain. A policy brings limitation of the number of days an initial opioid prescription can last. The new policy limits the number of the initial prescriptions, which is setting a 5 days supply limit for first time using opioid prescriptions.
- Advantages: to slow the opioid epidemic; limit over prescription of opioid addictive drugs for acute pain; and minimize the risk of opioid dependence. For patients who need an initial opioid prescription, supplying with 5 days or fewer opioid can reduces the likelihood of long term opioid use.
- Disadvantages: the number of pills dispensed will depend upon the strength of the opioid as well. Patients will also be prescribed opioids that provide pain relief over a shorter duration instead of a longer one. For some acute pain situations, such as fractured ribs, a 5 days supply is not reasonable in terms of effective pain relief. Clinicians will have a lot of appointments for refill related visits, which makes it more difficult to care for other patients.
- A federal restriction initial supply limit and dosage on prescribing opioid for pain management. Besides setting a 5 days limit for initial opioid prescription; the policy also imposes a dosage limit for long term use, which restricts the strength of the actual dose a clinician can prescribe. For long term opioid users, the policy will reduce their daily does to 100 MME.
- Advantages: Slow the opioid epidemic, and limit over prescription of opioid. Providers prescribe the lowest effective dose possible for the shortest duration and that’s effective at relieving a patient’s pain, which can reduce the tolerance. Limit daily dosages and require that immediate release formulations of drugs be given before extended release versions are prescribed.
- Disadvantages: For those chronic pain patients usually take dosage of 300 MME, this 100 MME limit is too restrictive and harmful to them. Because those chronic pain patients’ bodies have become tolerant to all but the highest doses.
- A federal restriction on prescribing opioid with authorized exemptions for certain patients, such as cancer treatments and hospice care. Prescribers should re-evaluate opioid prescriptions and provide other medications or physical therapy for pain management.
- Advantages: Slow the opioid epidemic, reduce prescription of opioid, and reduce the tolerance. Change clinician prescribing behaviors. Chronic pain affects 100 million Americans, but opioids are not appropriate for many pain patients. Patients with central pain syndromes, for example, tension headaches, respond better to antidepressant and anticonvulsant medications than to opioids. If opioids are prescribed, they should be used in combination with non-opioid therapy, such as exercise therapy and physical therapy.
- Disadvantages: For certain patients, physicians would have to seek authorized exemptions for those patients who need more medication or longer duration of opioids therapy. Some patients may desperate for relief and turn to heroin as their only option.
Policy Recommendation:
Easy access to prescription opioids has helped epidemic that now kills about 90 Americans every day. With hope to slow the epidemic and curb the nation’s opioid crisis, a federal restriction on initial supply and total dosage limit of opioid prescribing should be pursued as a way to prevent over prescribing which may lead to an opioid abuse. In addition, clinicians can obtain authorization for certain patients who are on cancer treatment or in hospice care. Even though this restriction policy may increase chances that patients come back to the clinics and ask for refills, it will prevent the possible development of physical or psychological dependence on opioid; change clinician’s prescribing behavior; and reduce the changes of abuse. Longer prescription durations and higher dosage will increase the likelihood of long term use of opioid. This policy is meant to balance the needs of the patient; to curb not just potential long term opioid use but also potential opioid misuse. The epidemic is getting worse, hidden in plain sight, and this policy is necessary to reduce the oversupply of prescription opioids.
References:
https://www.cdc.gov/drugoverdose/opioids/prescribed.html
https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170948/
http://www.nejm.org/doi/full/10.1056/NEJMsr1601307#t=article
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