They worry the bill places unreasonable restrictions on pain management efforts.
Legislation aimed at combating Florida’s opioid abuse problem is facing resistance from medical providers who worry the bill places unreasonable restrictions on pain management efforts.
The legislation – a top priority of Gov. Rick Scott’s and leaders in both legislative chambers – would make a variety of changes to state law. But the most significant is a requirement that opioid prescriptions for acute pain be limited to a three day supply, or seven days if a doctor determines it is medically necessary.
Palm Beach County hand surgeon Dr. Bradon Luskin told a state Senate committee Wednesday that even a seven-day supply of opioids often might not be enough for patients who have just undergone major surgery.
“It’s just not reasonable for somebody who’s incapacitated to have to come back every three to seven days,” Luskin told the Senate Health Policy committee, which held a workshop on the bill.
The committee initially was scheduled to vote on the legislation Wednesday, but the bill’s sponsor, Sen. Lizbeth Benacquisto, delayed the vote to work on some amendments.
Benacquisto, R-Fort Myers, said after the hearing that “we are looking at” the complaints raised by physicians. But she said the issue is “a balancing act” because statistics show people are more likely to become addicted the longer they’re on prescription opioids.
“I am going to be very careful about how we move forward with any adjustment to dosage timelines,” Benacquisto said.
The House sponsor of the opioid bill, Bradenton Republican Rep. Jim Boyd, also said he wants to be careful not to “water down the intent of our initiative” but added that “there may be some way to accomodate” some of the physicians’ concerns. The House Health Quality Subcommittee unanimously approved the legislation but only after lawmakers and audience members expressed a number of misgivings about various provisions.
Some lawmakers said they were sympathetic to physicians’ concerns about placing such tight limits on pain pill dosages, particularly when it comes to pills that are prescribed for major surgeries. Among the individuals testifying at both the Senate and House committee hearings was a representative for cardiac and neurosurgeons, who reiterated Luskin’s comments about a seven-day supply of pain pills being inadequate for some surgery patients.
Senate Health Policy Committee Chair Dana Young, R-Tampa, said testimony about heart surgery patients having their ribs cut open and needing extended doses of pain pills was particularly compelling.
“I think the issue of post-surgical care is certainly a reasonable question there are several ways that can be addressed,” Young said after the hearing.
Florida lawmakers are trying to address an epidemic of opioid abuse in the state. In 2016 there were 5,725 opioid-related overdose deaths in Florida, a 35 percent increase from 2015.
There were 263 accidental drug overdose deaths in Sarasota, Manatee and DeSoto counties in 2016 – a 7 percent increase – and most are attributed to opioids. Manatee County continues to be one of the epicenters of the opioid problem in Florida.
Manatee had the highest number of per capita deaths in 2016 from derivatives of fentanyl, a powerful synthetic opioid. The fentanyl derivative carfentanil killed 95 people in Manatee in 2016.
While deadly street drugs such as heroin and fentanyl have become a major problem in Florida, many opioid overdose deaths still are attributed to prescription pain pills and addicts often start on pain pills before moving to street drugs.
The state has tried to rein in pain pill abuse in the past, largely through the use of a database that tracks prescriptions in an attempt to identify patients engaged in doctor shopping and unscrupulous physicians who prescribe excessive amounts of opioids.
The opioid bill being pushed by Scott seeks to enhance the use of Florida’s prescription monitoring database, or PDMP. Currently nine states require physicians to check the state’s PDMP every time they prescribe a controlled substance. Another 12 states require doctors to check the PDMP when they first prescribe a controlled substance to a patient.
Florida has no requirement that doctors check the PDMP and many aren’t even registered to use it. That would change under the new legislation, which makes it mandatory for “a prescriber or dispenser” to check the PDMP and review a patient’s prescription history before issuing a prescription for a controlled substance.
Dr. Alan Miller, a Jacksonville pain management physician, told senators Wednesday that the PDMP can be clumsy to use, especially for doctors who aren’t pain management specialists.
“That should be a wake-up call for us that we can certainly improve the quality of our PDMP,” said Young.
Republican Rep. Cary Pigman, an emergency room physician from Avon Park, raised the issue of privacy when it comes to the PDMP. He wants to see older prescription information removed from the database. Rep. Byron Donalds, R-Naples, said he shares Pigman’s concerns.
“There’s a time where it needs to go away,” Donalds said.
All of the doctors who criticized the bill Wednesday said they support the overall effort to crack down on opioid abuse. And despite the pushback from the medical community, which has significant sway in Tallahassee, the bill has strong support from top lawmakers and is expected to advance.
“I think the bill is very narrowly focused for a good reason,” Benacquisto said. “I don’t anticipate a tremendous amount of changes.”