THERE’S NO simple way to stop opioid addiction and the evident epidemic of deaths associated with it.
To that end, Governor Charlie Baker is proposing to limit practitioners to prescribing no more than a 72-hour supply for a first-time opioid prescription. Exemptions would be carved out for patients suffering chronic pain, and for palliative, hospice, and cancer care.
The governor’s proposal is controversial because many doctors and dentists believe that they alone are best qualified to determine what their patients need, without such limits.
But Baker’s plan is worth a try.
In 2014, there were 1,089 unintentional opioid overdose deaths in Massachusetts — up 20 percent over 2013. According to the state Department of Public Health, statistics for 2015 suggest an increase in opioid overdose deaths over the same period last year.
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These casualties are sons and daughters, mothers and fathers. They are rich and poor, city dwellers and suburbanites. Their stories reflect a sad and common chain of events that sometimes begins with a prescription painkiller and, for four out of five, ends with heroin use.
Baker’s plan to limit prescription painkillers is opposed by the Massachusetts Medical Society, which views it as a misguided effort to block physicians from applying their own clinical judgment and expertise to a patient’s individual pain needs.
Instead of playing the role of Dr. No, however, the medical community should work with the Baker administration toward a compromise. Limiting first-time prescriptions to three days might be too restrictive and might also be too high an administrative burden on medical professionals who have to be available to refill them when necessary. So what about considering a five-day restriction?
The medical society, representing 25,000 physicians and medical students, argues that it has established its own opioid-related guidelines, which address patient evaluation and risk assessment with the goal of prescribing the lowest effective dose for the shortest possible time. It would be nice if those guidelines were enough to address the problem. But a public health crisis of this magnitude requires doctors to shoulder more inconvenience than they might choose on their own.
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Indeed, the numbers in Massachusetts are cause for concern. According to the Baker administration, 4.6 million prescriptions were written in Massachusetts in 2014, resulting in 255 million highly addictive pills in our medicine cabinets.
The Baker administration also cites a 2014 report released by the Centers for Disease Control, in which Massachusetts physicians ranked among the top 10 nationally for prescribing long-acting, high-dose painkillers. Other reports cast Massachusetts in a more favorable light when it comes to painkiller prescriptions. But quibbling over those numbers is counterproductive.