Bill Would Strictly Limit Opioids for Acute Pain

By Pat Anson, Editor

A bipartisan bill has been introduced in Congress that would put strict limits on the prescribing of opioid medication for the treatment of short-term, acute pain.

The bill by Senators John McCain (R-AZ) and Kirsten Gillibrand (D-NY) would require doctors to limit the initial supply of opioids for acute pain to seven days, a prescription that could not be renewed. The legislation is similar to recent laws adopted in several states, including New Jersey, Arizona and New York.

“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 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.”

“One of the main causes for the alarming increase in drug overdoses in the United States is the over-prescription of highly addictive opioids,” said McCain. “We have a long way to go to end the scourge of drugs across our communities, but this legislation is an important step forward in preventing people from getting hooked on these deadly drugs.”

Anti-opioid activists and government regulators have long claimed that even just a few painkillers can easily lead to addiction and death.

“You take a few pills, you can be addicted for life. You take a few too many and you can die,” former CDC Director Thomas Frieden recently told the Washington Post.

But only a small percentage of pain patients become addicted or overdose on prescription opioids. And research shows that less than two percent of patients who are prescribed opioids for acute pain become long-term users.

Under current federal law, doctors must receive a license from the Drug Enforcement Agency (DEA) to prescribe a schedule II, III, or IV controlled substance. The registration must be renewed every three years.

The 7-day limit would not apply to opioid medication used in the treatment of chronic pain or cancer pain, or for patients in hospice care, end-of-life care or palliative care. However, it would prevent doctors from prescribing any opioids for any type of pain if they don't promise to limit prescriptions for acute pain:

“The Attorney General shall not register, or renew the registration of, a practitioner…  who is licensed under State law to prescribe controlled substances in schedule II, III, or IV, unless the practitioner submits to the Attorney General, for each such registration or renewal request, a certification that the practitioner, during the applicable registration period, will not prescribe any schedule II, III, or IV opioid, other than an opioid prescription… for the initial treatment of acute pain in an amount in excess of the lesser of a 7-day supply (for which no refill is available) or an opioid prescription limit established under State law.”

Schedule II opioids include painkillers with “a high potential for abuse” such as hydrocodone, fentanyl, morphine, and codeine. Schedule III opioids have “a potential for abuse” and Schedule IV opioids have “a low potential for abuse.” Opioids such as Suboxone and buprenorphine, which are generally used to treat addiction but are also being abused, are exempted from the legislation.

Anti-anxiety and antidepressant drugs such as Xanax, Soma and Valium – which are classified as Schedule IV controlled substances – are also not covered by McCain and Gillibrand’s bill, even though they are involved in a substantial number of overdoses. The bill was assigned to the Senate Judiciary Committee.

“It’s only too obvious, a careless clueless Congress and state governments have forgotten the lessons of the drug wars and prohibition as they seem intent on repeating the mistakes of the past instead of learning from them when it comes to opioids,” said David Becker, a social worker and patient advocate in New York.

“Furthermore, it is clear they could care less how their opioiphobia harms not only people in pain but their loved ones and those that care and depend on them. It’s clear they never had a real plan to help people in pain but allowed doctors, insurers, and researchers to do their own thing -- unless headlines showing the harms of their lazy laissez faire policies threatened their careers.”