Bipartisan Bill to Limit Opioid Prescriptions Won’t Fix the Overdose Crisis

Senators Kirsten Gillibrand (D-NY) and Cory Gardner (R-CO) are in the news this week for a bipartisan bill they introduced to combat the opioid crisis, but that news coverage is not quite the praise they were expecting.

Chronic pain patients are mobilizing to oppose the bill, fearing that it may limit access to necessary pain control and noting that it doesn’t actually address the root causes of the opioid epidemic; it’s like claiming that people who need antibiotics to treat severe infections are responsible for the rise of antibiotic resistance.

At a time when 130 people are dying every day of opioid overdoses – including prescription and street drugs — every day, we clearly need action on the opioid crisis. It’s ravaging communities and ruining lives at tremendous cost.

The question of how best to address the issue has been a topic of lively discussion, and many advocates believe this proposal will hurt people with medical needs, including anyone who needs opioids to manage their health care needs.

The House also has its own version, introduced simultaneously by Republican John Katko of New York. The specifics of both versions aren’t available because the text hasn’t been published yet — but we do have a sense of what’s involved, thanks to information about a prior bill and this tweet from Senator Gillibrand:

Her comments suggest that this legislation is more for show than it is about seriously addressing this problem — because it will do next to nothing to address the opioid crisis.

Did overprescribing cause the opioid crisis? That’s certainly what you’ve heard from the headlines, but chronic pain patients are not the ones responsible for the flood of opioids into the market, and treating pain seriously is not why we’re facing this crisis. Diversion of drugs to friends and family is an issue, as are unscrupulous “pill mills,” and so is a flood of cheap street drugs.

It’s clear that some physicians are overprescribing — those pills didn’t fall off the back of a truck. So restrictions on prescribing practices might make sense to people who aren’t familiar with the policy challenges at work here, which is why Gillibrand’s proposal may seem superficially appealing.

The problem is that “acute” pain often lasts more than seven days, as anyone who’s had invasive surgery knows. Some people are back up and about on day two, while others experience significant pain that cannot be managed with over-the-counter drugs, and poor pain management actually impedes healing.

If this bill mirrors prior legislation, patients would be required to get a new prescription, possibly requiring a doctor’s visit, after seven days. Some people facing recovery from serious injuries or surgeries aren’t going to be in a fit state to do that, and their physicians know it — which is why they prescribe drugs for a longer period of time based on their experience and knowledge of the patient.

As for chronic pain patients, Gillibrand claims to have accounted for them, and for patients with terminal illnesses too. The problem is that chronic pain and terminal illnesses aren’t overnight diagnoses.

Pain patients need to show symptoms of pain for at least six months, and sometimes longer, before receiving a chronic pain diagnosis. Imagine going to the doctor’s once a week during that time. Or receiving emergency surgery for a mysterious mass and having your pain management doled out a week at a time until the pathology report definitively identifies it as cancer. Or living with extended acute pain in kidney failure while doctors decide whether the diagnosis is terminal.

Limiting the amount of opioids floating around is certainly a strategy to address the opioid epidemic, but it would be wiser to do that through medical board discipline and evidence-based medicine. Some doctors may prescribe high volumes of opioids because they are surgeons, pain specialists or providers in other populations with high incidences of pain. Others may do so because they are running pill mills.

Cracking down indiscriminately on prescribing already has patients reporting that their physicians are cutting back on prescriptions for fear of disciplinary retaliation like losing their licenses. That harms patients, and it doesn’t fix the opioid problem.

The bigger issue here is lack of access to treatment for substance use disorders. The same prescribing restrictions designed to limit the proliferation of opioids can also make it hard to prescribe medications like buprenorphine, which is used to treat substance use disorders. When people with substance use disorders wind up in the ER, few hospitals have a system in place to refer them to treatment, thereby helping them get care and reducing the need for future emergency treatment.

Entities like Medicaid limit the duration of substance use disorder treatment, while private insurance providers can have scant coverage options available. And even as the GOP complains about substance use disorders, Republicans continue to push budget cuts that will curtail Medicaid’s coverage even more. Meanwhile, when people with substance use disorders enter the injustice system, they may get treatment … but no followup when they get out, leaving them vulnerable to overdose.

Legislators who are serious about this issue should leave the practice of medicine to the doctors and focus on ensuring that a wide range of substance use disorder treatment options are readily available and affordable. They also need to address the socioeconomic inequalities that make substance use disorders more common in economically disadvantaged areas, where a sense of helplessness and fatalism can lead people to substance use as an escape from the world around them.

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Photo credit: Phil Roeder/Creative Commons

30 comments

Paulo Reeson
Paulo R26 days ago

ty

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Karen H
Karen H2 months ago

Between August 2018 and February 2019, I had THREE different doctors prescribe opioids. The first was when I had a hysterectomy (after detection of endometrial cancer). Second was after I had the port put in for the chemotherapy - even after I told the doctor I already had medication for pain (and I hadn't had any pain, so I hadn't taken any pills). The third was when I was experiencing leg pain from the chemo. I told the doctor I already had TWO prescriptions for opioids, but since they contained acetaminophen, which could mask a fever, the doctor said I couldn't take them. I said I did NOT want an opioid. It was prescribed anyway. I hadn't taken any of the first two prescriptions, but when the leg pain got really bad, I took one of the new ones and had EVERY side-effect listed on the internet, plus a few more. I stopped taking them, called the doctor and said, "I'll deal with the pain instead of the side-effects." I took all 3 prescriptions to the police department and dropped them in the "bad drug" container.

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Amparo Fabiana C

Unbelievable, poor people with real pain, they need their meds, surgery patients. Just because some abuse them. What about the guns those really kill quickly innocent people. Drugs are there for a reason, a medical one. Not for abusing and taking 10 pills a day.

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Clare O'Beara
Clare O2 months ago

th

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Susanne R
Susanne R2 months ago

If trump manages to repeal the ACA, the opioid crisis is going to intensify and result in many more deaths. Under the ACA, subscribers are able to access treatment for substance abuse, and the children of health care subscribers are covered until they're 26 years old. Eliminating the Affordable Care Act will deprive many users of the treatment they need to help end their substance abuse.

Source: Clinical Psychiatry News) - "Since the ACA's implementation, an estimated 20 million Americans have gained health insurance. The ACA includes several provisions that made this number possible, such as the expansion of Medicaid in some states. In addition to plans offered through the Health Insurance Marketplace, private insurers are required to provide insurance to some who previously fell into non-coverage gaps. Young adults can remain on a parent’s plan until age 26, which is significant to mental health care because many psychiatric disorders emerge in young adulthood, and this age group is vulnerable to developing substance use disorders.

The ACA also requires private insurance plans to cover those with pre-existing health conditions. This has been crucial for persons with mental illness because before the ACA, mental health disorders were the second most common preexisting condition that precipitated either an increase in the cost of a plan or coverage denial."

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Marija M
Marija M2 months ago

tks

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Peggy B
Peggy B2 months ago

TYFS

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David C
David C2 months ago

an incredibly complex issue....any simple solutions are not easy solutions

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Dr. Jan H
Dr. Jan Hill2 months ago

thanks

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Debbi W
Debbi W2 months ago

I agree with Senators Kirsten Gillibrand and Cory Gardner. They must understand how addictions works in order to help addicts. Terminal patients should not be included. They should have as much pain killers as they want in order to be comfortable. How could anyone deny them that?

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