The proposal, announced by the administration Wednesday, would cap prescriptions at between nine and 12 pills for some minor procedures, depending on the type of painkiller and the procedure.
Gov. Peter Shumlin outlined a proposal to cap prescription painkillers in his state of the state address in January. The Legislature ultimately passed a bill charging the commissioner of the Health Department with drafting rules guiding prescription limits.
“There is no doubt that because we’re handing out painkillers like candy we have the opiate addiction and heroin addiction crisis that we’re facing as a state,” Shumlin said Wednesday afternoon.
“We’ve asked the question, what are all the things that we can do to get our arms around this crisis,” Shumlin said.
In 2015, there were 100 opiate painkillers prescribed in the state for every Vermonter, according to the administration.
“When you look at the number, it’s kind of staggering,” Shumlin said. He said the rules will be a step toward “a more sane way of prescribing drugs.”
Shumlin said he is “proud” of his administration for drafting “what are the toughest policies in the country” for prescribing opiate painkillers.
“No more are the days when you get 50, 60, 70 pills and they send you out the door,” he said.
Health Department Commissioner Harry Chen said he developed the proposed rule after holding 20 meetings throughout the summer with dozens of providers, ranging from emergency room physicians to surgeons to dentists.
Chen said there is a clear pattern of over-prescribing. On average, he said, people used only half the amount of pills they received after a minor procedure.
There is also “tremendous” disparity between different doctors on how many painkillers are prescribed for the same surgery.
The goal, he said is “to really limit the pipeline of people who are exposed and the amount of drugs on the market,” Chen said.
Based on the meetings he held with providers, Chen and the Health Department proposed a framework for prescribing that takes into consideration the complexity of the procedure and the amount of pain associated with it.
The framework begins with the presumption that for some procedures and injuries — such as a sprained ankle or a minor hand surgery, for instance — doctors should not be prescribing opiates at all.
For minor procedures, the cap starts at between nine and 12 pills for prescription.
The proposal will also change how opiates are prescribed for children. Parents will need to provide a signature, and the prescriber will be required to attempt to contact the child’s pediatrician or primary care provider.
The proposed rules will not restrict patients from getting refills on prescriptions should they need them, he said, but will limit initial over-prescribing.
“A lot of this, the prescribing was done for convenience,” Chen said. Given where we’re sitting in the midst of the opiate crisis, I think that convenience is not an adequate rationale for overprescribing.”
The proposal still must go through the rulemaking process. A public hearing on the proposal will be held at the Health Department offices in Burlington on Friday afternoon from 1 p.m. to 2 p.m. Public comment is open by email through October 28.
The administration expects the rule will be finalized in December according to a statement from the governor’s office.
Jessa Barnard, general counsel and vice president for policy at the Vermont Medical Society, said that the group is supportive of the intention of the proposal, but has some concerns about details in the implementation.
“Our biggest concern overall is the level of intricacy of the rule and the lack of clarity with certain provisions,” Barnard said.
The society is wary of adopting a “blanket cap” that may not be the best solution for all patients, she said. However, she emphasized that members are supportive of safe prescribing practices and safe handling of opiates.
The Vermont Medical Society submitted comments on the proposals earlier, and was involved with one meeting with Chen in the drafting phase. She said that the group plans to submit suggestions for improving the proposal at the public meeting later this week.
