Lawmakers advance doctor pain pill limits | VTDigger
 

Lawmakers advance doctor pain pill limits

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.

Claire Ayer

Sen. Claire Ayer, chair of Senate Health and Welfare.

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.

Elizabeth Hewitt

Leave a Reply

35 Comments on "Lawmakers advance doctor pain pill limits"

Comment Policy

VTDigger.org requires that all commenters identify themselves by their authentic first and last names. Initials, pseudonyms or screen names are not permissible.

No personal harassment, abuse, or hate speech is permitted. Be succinct and to the point. If your comment is over 500 words, consider sending a commentary instead.

We personally review and moderate every comment that is posted here. This takes a lot of time; please consider donating to keep the conversation productive and informative.

The purpose of this policy is to encourage a civil discourse among readers who are willing to stand behind their identities and their comments. VTDigger has created a safe zone for readers who wish to engage in a thoughtful discussion on a range of subjects. We hope you join the conversation.

Privacy policy
Sort by:   newest | oldest | most voted
Jim Vires
5 months 18 days ago

One unintended consequence will be the requirement for patients with ongoing pain issues to make numerous trips to the doctor to get a new prescription written. This cannot be done over the phone and might present a challenge to people with limited ability to travel if it be from pain, lack of transportation, or finances.

Jan van Eck
5 months 18 days ago
Assuming your recited unintended consequence becomes the case, then it will be even worse. Take the situation of an injured person (industrial accident to limb, for example a crushed hand in a machine) which has left irremediable pain. Each individual prescription will require payment of a separate co-pay or deductible. Absent bulk buying, the costs of pain meds to the injured person in chronic pain now shoots up by some 1,000 percent. Meanwhile, the injured is without income other than disability under SSI, or the equivalent. So yet another unintended consequence is further impoverishment of injured persons in pain. Just… Read more »
Don Dalton
5 months 17 days ago

It’s my understanding that the bill only addresses acute, not chronic, pain issues.

Neil Johnson
5 months 14 days ago

Instead of our lawmakers trying to be doctors, they could just monitor the doctors through their licensing. That is what the licensing is for.

It’s all in writing, any pharmacist can tell you or provide the documentation of over prescription. We don’t need more laws, we need our licensing board to do their job. Just the phone call of the licensing board to any doctor would surely change practices, wouldn’t even need to investigate.

John Skalecki
5 months 18 days ago

So Shumlin is a MD now? Imagine that! He knows how much pain medication needs to be prescribed for any given medical procedure. Am I the only one who sees the insanity here? The lawmakers should not be allowed to dictate what a doctor prescribes, period.
Pill limits? Bad idea again. Less pills just means higher doses. If Shumlin gets his way you will see the overdose rate skyrocket even more. Gimme a break!!!!!! You just cant make this stuff up.

Don Dalton
5 months 17 days ago
I respectfully disagree 100%. If terrorists were killing tens of thousands of US citizens per year the whole country would be mobilized and no expense would be spared. Yet if opioids kill tens of thousands per year (as they do) we’re divided on the issue and frame it in terms of “rights.” We’re quick to invoke “rights” if something interferes with pharma profits (as opiate restriction would) yet on the other side of the fence, if people refusing vaccines interferes with pharma profits, then we’re far too quick to take away rights. Physicians have restrictions on prescriptions to counter opioid… Read more »
5 months 17 days ago

“tens of thousands of US citizens per year”…citation, please. I know it’s a lot but you may be overstating the case of prescription opiates and including deaths from heroin.

Don Dalton
5 months 17 days ago
This statistic is from 2013; today it’s likely higher. It’s from a book by Barry Meier on OxyContin. The statistic from 2013 is that 16,000 people die from prescription opioid overdoses each year. http://www.npr.org/2013/05/29/186927127/how-oxycontins-pain-relief-built-a-world-of-hurt Maybe people are opposed to taking reasonable measures to stop this epidemic because they don’t understand how bad it is– I don’t know. I don’t understand. We have a huge problem of opioid addiction that has been exacerbated by the over-prescription of opioids by the medical profession, and this in turn was caused by fraudulent marketing of opioids as “generally non-addictive” in a clinical setting. Boy,… Read more »
rosemarie jackowski
5 months 17 days ago

Many patients have taken opioids for years and never become addicted.
Only those totally lacking in compassion would deprive patients from any medication they need. Even the FDA has approved opioids for children.

It is a myth, that everyone who uses pain meds becomes an addict.

Don Dalton
5 months 16 days ago
No one said that everyone who uses pain meds becomes an addict. Nevertheless, we know that the opioids are addictive. OxyContin is highly addictive. I don’t think the argument is over denying pain meds to those who need them. The real argument is that we’ve been handing out pain meds like candy, and in many cases still are, and if this doesn’t stop our addiction problem will only become worse. Many do become addicted. We also know that in many cases those who are cut off from prescriptions turn to heroin. This is no mystery. The FDA, is my opinion,… Read more »
Gary Shattuck
5 months 18 days ago
For a bit of historical perspective, here are a couple of excerpts from letters written by state officials in 1967 (both are in the state archives in Middlesex): In a letter dated December 13, 1967, John F. Stephens, Secretary of the Vermont Board of Pharmacy writes: “Pharmacy is well controlled compared with the medical profession in this state. I can show you letters I have written to physicians informing them of the law of this state, as well as the law of the land. One physician authorizes refills “for duration of illness,” and this can lead to severe abuse, another… Read more »
Jim Candon
5 months 17 days ago

In the late 1970’s and early 1980’s the state police diversion unit saw the move by drug seekers to Schedule II and III Rx painkillers, what we now call Rx opiates. At that time the drug seekers would find naive doctors to whom they could fake pain and then receive Rx painkillers. The drug seekers would then use the drugs, sell the drugs or a combination of both.
The diversion unit also discovered a surprising amount of Rx drug abuse within the medical care field itself, involving physicians, pharmacists and nurses.

Gary Shattuck
5 months 17 days ago

And that is consistent with historical facts, finding that no less than 16% of all doctors in the country were addicted by the early 20th century. One would suspect that in this highly scrutinized time things have changed, but it looks like we will never know unless pharmacy records are examined more closely than they were when you were doing diversion work.

Question: what is the diversion unit doing today? What are they uncovering? What have been the results of their investigations? Do they even exist? They seem to be missing from the conversation….

Jim Candon
5 months 16 days ago
The state police were told more than 10 years ago to stop doing random inspections of the scheduled drug files ( drugs with the potential to be habit forming and subject to abuse like OxyContin and Percodan) within Vermont pharmacies. This was done in contradiction of their “duty” to do so as directed in Title 18, section 4218, Vermont Statutes Annotated. And subsequent to that the legislature further eroded any compliance inspections by denying the state police access to the Vermont Prescription Monitoring System. Efforts today by the state police to prevent the diversion of dangerous Rx drugs are done… Read more »
rosemarie jackowski
5 months 18 days ago

Chronic pain patients are being thrown under the bus for political reasons. Politicians should stay out of the doctor/patient relationship.

Ironic that this is happening is a State where Assisted Suicide is legal – but pain relief is under attack.

3 months 12 days ago
I have had 13 spinal surgeries, I crushed vertebrae in a matter in 1997. ,I became a patient of pain management center on tilley drive in south burlington 12 years ago..I was prescribed methadone, they tried to put a spinal stimulator in five different times. Did not work, I still have paddle on spine, and leads on my spine..but no pain relief. My doctor unfortunately became ill, the office immediately cut me 40 mg a day, month later cut me 40 mg more, within 2 months half the dose I have been on up to 12 yrs…never failed urine sample,… Read more »
David White
5 months 17 days ago

May I suggest writing some legislation that would effectively ban POLITICIANS from making any MEDICALLY related decisions at all.

Mary Martin
5 months 17 days ago

Please leave this decision on prescription dosage with the professionals. Yes, abuses have occurred but that is not the norm for our highly qualified medical community. When all the legislators have completed medical or pharmaceutical courses, they can readdress this issue with the knowledge they need. Meanwhile, stay out of the doctor’s office.

Don Dalton
5 months 17 days ago
Abuses have occurred? Do you have any idea of what is going on in Vermont, in Maine, in Kentucky, in Florida, all over this country? My mother in Florida was addicted to pain killers, a situation that caused her great anguish since, being the wife of a minister, she felt she’d descended into being an addict. Why are people defending drugs so ardently? What’s going on? I don’t get it. Do you have any idea about what’s happening? In Appalachia, they call it “pharmageddon”– how prescription drugs have devastated whole communities. Interestingly, that’s also the title of a book by… Read more »
Renée Carpenter
5 months 17 days ago
“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.” Good start to a problem with deep roots, and that requires deeper exploration. The Health Commissioner and VT Medical Association(s) have a particular framework of thinking that isn’r necessarily as inclusive as it must be to resolve problems with health CARE, including addiction to pharmaceuticals. How health insurance coverage works–by not including complimentary practices that can alleviate pain… Read more »
Randy Jorgensen
5 months 17 days ago
Doctors don’t like being told how to treat their patients, especially from politicians. Although I can’t say for sure this will most likely cause more doctors to decide to practice in other states. Doctors are highly educated, as such are also highly mobile. Folks aren’t getting hooked on pain meds from “minor” procedures like a hernia surgery, they’re getting hooked on pain meds for chronic pain, such as knee problems where surgery is required and you need to take the pain meds before you can even start PT, then often continue them while in PT. “Medical professionals also resisted a… Read more »
rosemarie jackowski
5 months 17 days ago

The Prescription Drug monitoring data base is a violation of patient privacy. That data base puts every patient at risk of having their home invaded. Imagine – a list of names and addresses of homes where there could be prescription drugs. What could make things easier for addicts and dealers. Unintended consequences.

Please don’t tell me that web sites cannot be hacked.

Gayle Hansong
5 months 17 days ago

I am sorry but the idea of having legislators determining what doctors should prescribe for their patients is as ridiculous as convening the AMA and asking them to create legislation governing the transportation budget.

Don Dalton
5 months 17 days ago
Health Commissioner Harry Chen is correct when he says that the culture has been one of abundant prescribing of opioids, and that culture should be changed. I’m not for government interference. But if we do nothing, then pharma has a green light to keep pushing the envelope for more and more prescriptions. I think those who complain about government interfering with doctors are short-sighted: we have a huge problem of opiate abuse on our hands, and surely a little reigning in of this wild abuse of opioids is a reasonable measure. The medical profession hasn’t been very good at getting… Read more »
Jan van Eck
5 months 16 days ago
Mr. Dalton, I would say that your thoughtful analysis, above, is trenchantly accurate. Yet, you are looking at your narcotics-abuse problem through a very local lens. Your Windham County has these problems due to local leadership failures; you have this entrenched set of politicians, government officials, and businessmen (collectively, “the power elite”) that is perfectly comfortable with the situation as it exists. Those folks, whom you elect or appoint, like it the way it is. Your solution is, ultimately, to dump your power elite. Society has two classes of druggies. One group, perhaps 5% of the population, is predisposed to… Read more »
Don Dalton
5 months 16 days ago
It’s not just Windham county. This is a problem all across the country. Appalachia has been devastated, as has rural Maine. I agree with your solution: people need to feel worthwhile and we need jobs. I’m not so sure that there is a “natural” 5% of the population prone to substance abuse, and that nothing can be done for them. For those who say leave doctors alone, I’d say OK, provided that doctors can use any and all measures to treat addicts, with no restrictions. Why make doctors jump through hoops to treat addicts and in many cases deny them… Read more »
Jan van Eck
5 months 16 days ago
As to the residual, or “natural,” background level of persons inherently susceptible to substance abuse, you see this (in varying degrees) in certain populations. Specifically, Ireland has a long-standing problem with its indigenous population abusing alcohol, easily 5%. Whether or not that is genetic predisposition, I leave to epidemiologists to sort out (I suspect it is). The Irish natives are now also engaging in narcotics/pharma abuse, another big problem there. How to treat, and especially how to treat the fringe or “swing” populations that drift into substance abuse? Yes of course, you are perfectly correct, leave physicians alone to their… Read more »
Don Dalton
5 months 16 days ago
I would not be so quick to paint the Irish as disposed to abusing alcohol or drugs. Yes, that’s the popular myth, but I wonder how true it is? Don’t Italians and Germans, for example, drink too? Irish natives engaged in narcotics/pharma abuse? Where did that come from? I’m Irish, and proud of it. And no, I am not and never have been an addict of anything. I’m also not so sure that addicts can be painted into the “morally defective” group, as you seem to. Was my mother morally defective when she became addicted to painkillers? As she is… Read more »
5 months 17 days ago

I think this bill is about 10 years late. Doctors have moved to a pain management model and have already decreased the opiate prescriptions – hence the friendly heroin dealers that have moved in to fill the void.

Jim Candon
5 months 16 days ago

Not so if you were to check the latest stats published by the Vermont Prescription Monitoring System.

5 months 17 days ago

I’d also like to give a shout out to Perdue Pharma, manufacturer of both Oxycontin and Suboxone. One helluva business model you got there, boys.

Neil Johnson
5 months 14 days ago

Do they make the medicine to relieve constipation from using opiates too? Which is allowed to advertise on TV due to the lobbyists of Big Pharma? The circle of a drug dealers life.

The Suboxone market paid for by tax payers? So now the addicts get free drugs?

Rich Lachapelle
5 months 16 days ago
I dont understand all the hysteria about government getting involved in medicine which is the situation we have now with some therapeutic drugs being prescription-only and many popular recreational drugs and the illicit use of therapeutic drugs being prohibited by law. Certainly there are issues of patient privacy but these issues exist now with the government being involved in the financing of many aspects of health care in general. To get the government out of the drug business means legalizing all drugs and allowing the pharmaceutical companies to promote and market all their products free of interference. This would not… Read more »
Rich Lachapelle
5 months 16 days ago
Every time a US citizen seeks to take advantage of their 2nd Amendment rights by purchasing a gun from a dealer there is a federal requirement for a criminal, mental health and domestic violence background check to determine whether that person is on the “prohibited” list. When someone wants to board a commercial airliner they must produce a government-issued ID and not be on the “no fly list”. We tolerate these intrusions on our rights and liberties because of the POTENTIAL FOR GREAT HARM that can result if the wrong person has access to these devices. We have already seen… Read more »
3 months 12 days ago
I think limiting pain medicine is total insane!! I am 53 years old and I am on disability, for several reasons, if I didn’t have my pain meds,I wouldn’t be able to do a thing, and all people are different about the pain that there in, and limiting pain meds,after an major operation ,is just not a good idea!! Do you realize the crime this limiting is going to go threw the roof!! And if people get taken off there pain meds,there going to go and by them off the streets anyways, and start using herion! ! A few years… Read more »
wpDiscuz
Thanks for reporting an error with the story, "Lawmakers advance doctor pain pill limits"