New rules on opioid prescribing
► Tightened rules on hydrocodone: In fall 2014, the US Drug Enforcement Administration reclassified hydrocodone, the main ingredient in Vicodin, Lortab, and other commonly used medications, into a more tightly controlled category. Patients can still get up to a three-month supply but no refills are allowed, requiring patients to visit their doctors when they need more. Before the change, hydrocodone-containing drugs were the most commonly prescribed medications — and among the most commonly abused.
► Governor Charlie Baker’s opioid law: The legislation, signed in March, includes requirements that prescribers evaluate patients’ risk factors for addiction and enter into written pain-management agreements. The law limits first-time opioid prescriptions to seven days, unless the prescriber documents a medical reason for longer treatment.
Additionally, the law directs the Department of Public Health to inform doctors annually if the amount of opioids they prescribe is greater than the median or the average for their specialty — a provision some critics say could induce physicians to stop prescribing opioids altogether.
► CDC guidelines: The US Centers for Disease Control and Prevention in March adopted guidelines for prescribing opioids for chronic pain, including uncontroversial recommendations to assess patients for risk of addiction, to discuss risks and benefits with patients, to establish treatment goals, and to evaluate benefits and harms as therapy continues.
But the guidelines also recommend a maximum dosage for opioids, the equivalent of 90 milligrams of morphine per day. Critics say that ignores vast differences in how patients respond to opioids.
► MassHealth dose limits: Effective March 7, MassHealth, the state’s Medicaid program, capped the opioid dosage that it will pay for at the equivalent of 120 milligrams of morphine a day. A MassHealth spokeswoman said there is a lack of evidence that higher doses are effective, and clear evidence they can be harmful. Providers may seek approval for higher doses if they can document the need, and so far 521 have filed such requests.
Felice J. Freyer