Lawmakers moved forward Friday with a bill that could put limits on the amount of opiate painkillers a doctors could prescribe.
Sen. Claire Ayer, D-Addison, chair of the Senate Health and Welfare Committee, described the legislation as taking “an upstream approach” to the opiate crisis.
The bill, S.243, gives the commissioner of the Department of Health authority to set limits on how many opiate painkiller pills a doctor can prescribe at a time and how to track the distribution of those medications through a statewide database system.
The legislation directs the commissioner to determine the rules on opiate drugs in consultation with a panel of medical professionals — which includes representatives from many Vermont medical associations, ranging from substance abuse experts, to pharmacists, to dentists, to a licensed acupuncturist.
The governor highlighted a pill limit for minor procedures as one of his priorities for the session in his final State of the State address in January. In that speech, he called for a 10-pill limit, but lawmakers were leery of using a specific number.
In a statement Friday, Gov. Peter Shumlin hailed the build-out of Vermont’s opiate addiction treatment system in recent years as “staggering,” but said there is a need for structural adjustments.
“But we will never fully address this crisis until we attack the source of the problem: F.D.A. approved opiates that are handed out like candy,” Shumlin said. “There is no medical reason that someone who undergoes a minor procedure should be sent home with 80-100 highly addictive opiate pills.”
Shumlin has also taken on prescription drug availability on a national stage. In February, he led a push for creating nationwide prescribing protocols for opiates at a National Governors Association meeting.
But the proposal ran into some opposition from the medical community.
In a memo issued last week, the Vermont Medical Society raised concerns that a “one-size-fits-all” policy could potentially result in “unintended consequences for patients.”
Medical professionals also resisted a proposal to require them to check with the Vermont Prescription Monitoring System, a database that tracks the prescription of certain types of medications to patients, every time they prescribe a drug, saying that it would be time consuming. The bill also gives the panel and the commissioner the authority to make rules guiding those requirements.
Ayer said that the committee decided to defer ultimate decision-making authority on pill limits for different types of procedures to the medical community. “We’re a citizen’s legislature,” she said, noting they prefer those decisions be made by experts.
Health Commissioner Harry Chen said Friday it is important to “make some efforts to change the culture, and the culture really has been abundant prescribing.”
Chen said that although the bill does not include Shumlin’s specific State of the State call for a ten-pill cap on initial prescriptions after minor procedures, the legislation does express a desire to move away from over-prescribing.
“The number ten is no longer in there, but there’s certainly a clear expression of intent that there will be some limitations,” Chen said.
Under the current system, the same type of procedure may result in a wide range of painkiller prescriptions, Chen said. He’ll work with providers to try to find some standards.
The prescription opiate limit was part of a wide-ranging 29-page bill that passed Health and Welfare Friday.
The bill also increases a fee that pharmaceutical companies pay on medications that are covered by Medicaid, Dr. Dynasaur or VPharm from 0.5 percent to 1.24 percent. The revenue will in part go to funding an analysis of methods of pain management that don’t involve pharmaceuticals.
The legislation also establishes a telemedicine pilot program under which certain patients who are in recovery can receive some treatment from a specialist remotely through a telemedicine portal based at a health care provider.
The pilot could help to make treatment more accessible for people who have limited access to transportation, Ayer said.