Kentucky OKs Nation's Toughest Limits on Pain Pills

by | June 30, 2017

By Daniel Desrochers

The number of drug-overdose deaths in Kentucky has climbed the past four years, culminating in an all-time high of 1,404 in 2016. It is hoped that a new law restricting opioid prescriptions, which takes effect Thursday, will reverse the trend.

By placing a three-day limit on opioid prescriptions for acute pain, such as removal of wisdom teeth, lawmakers hope House Bill 333 will hit the opioid epidemic where it often starts -- prescriptions from well-intending physicians. A 2013 study found that 80 percent of heroin users reported using prescription opioids before heroin.

"The elephant in the room is that we have mistreated pain for years," said Dr. Ryan Stanton, a physician in Central Baptist Hospital's emergency department. "We have used opioids as the 'easy button' when there are better, less addictive options on most pain-related conditions. We have to be supported to go with the evidence and research like we would in almost every other facet of health care."

While the law officially goes into effect Thursday, along with dozens of other laws approved by the General Assembly earlier this year, doctors won't have to abide by the new standard immediately. First, the Kentucky Board of Medical Licensure must develop regulations to implement the rule, a process that includes a public hearing.

Kentucky is one of several states that recently limited the amount of painkillers physicians can prescribe for acute pain, but the Bluegrass State's three-day limit is the tightest in the nation, said Van Ingram, director of the Office of Drug Control Policy.

Ingram said Kentucky's new rule is based on prescribing guidelines suggested by the federal Centers for Disease Control and Prevention. "For an overwhelming majority of acute situations, three days will be enough," he said.

When it's not enough, Ingram said, there will be built-in exceptions to the rule allowing a doctor to increase the prescription.

In Massachusetts, Gov. Charlie Baker originally proposed legislation that would place a three-day limit on painkillers, but lawmakers balked and Baker signed a bill in March 2016 that contained a seven-day limit.

Kentucky's doctors and hospitals did not lobby hard against the new law, other than debating whether the limit should be set at three, five or seven days, Ingram said. Nationally, the American Medical Association has taken a similar stance, while warning that doctors should always decide what's best for a patient.

"The AMA wants to make sure that prescribing decisions -- the decision to prescribe or not to prescribe -- stay in the hands of physicians," Dr. Patrice A. Harris, the chairwoman-elect of the AMA, told the New York Times in February 2016.

Ingram said the point is to get doctors thinking about how they prescribe painkillers.

"I think the biggest impact is to get prescribers to hit the brakes and say 'how much do I need to prescribe in this situation?'" Ingram said.

Opioid prescriptions in Kentucky went down 11 percent between 2013 and 2015, according to the Pew Research Center, though doctors still prescribed more than 10.6 million controlled substances between June 2015 and July 2016, according to the Kentucky Office of Drug Control Policy's 2016 report.

Medical experts say that while limiting prescriptions can help prevent future drug abuse, it does little to help people who are struggling with addiction.

"The laws thus far have not changed the overdoses," Stanton said. "In fact, the numbers continue to grow. That's because these restrictions don't address the addicts that have already been created. In fact, the cat is out of the bag at this point. We do need to tighten rules and adjust to evidence-based practice to better treat pain and prevent further addicts. We also have to expand and bolster recovery resources to help the addicts."

The law's sponsor, Rep. Kimberly Moser, R-Taylor Mill, had a second bill that focused on recovery and treatment for addicts, but it failed to pass the Senate on the final day of this year's legislative session.

The new law does, however, include harsher penalties for heroin and fentanyl dealers. Fentanyl is a synthetic opioid that can be up to 50 times more potent than heroin. Fentanyl is often mixed with heroin, sometimes without the user's knowledge, which can lead to an overdose.

The law will expand the legal definition of fentanyl, a technicality that will help law enforcement prosecute fentanyl dealers.

"That's important because we've seen some fentanyl analogs show up that we've never seen before," Ingram said.

(c)2017 the Lexington Herald-Leader (Lexington, Ky.)