Where Opioids Are Deadliest, the State Limits Prescriptions
By Wendy Holdren
Gov. Jim Justice signed into law Tuesday a measure to limit the duration of opioid prescriptions issued in West Virginia -- the state with the highest overdose death rate in the nation.
The Opioid Reduction Act, which passed nearly unanimously in both chambers, limits initial opioid prescriptions to a seven-day supply. Prescribers are also encouraged to prescribe the lowest effective dose for treatment.
The Act also requires practitioners, before issuing an initial prescription, to take a thorough medical history, including substance misuse; to develop a treatment plan, with particular attention focused on determining the cause of the patient's pain; and to access relevant drug monitoring information on the Controlled Substances Monitoring Program database.
For adults seeking treatment in an emergency room or urgent care facility, practitioners are limited to four-day prescriptions.
A Center for Disease Control and Prevention (CDC) study has shown the probability of long-term opioid use increases most sharply in the first days of therapy, particularly after five days or one month of opioids have been prescribed, and levels off after approximately 12 weeks of therapy.
The study was published in March 2017 in the Center for Disease Control and Prevention's Morbidity and Mortality Weekly Report.
West Virginia's new law limits dentists and optometrists to three-day prescriptions. Minors, too, may only receive a three-day supply. Practitioners must discuss with parents or guardians the potential risks of opioid use.
Before issuing a prescription of any duration, practitioners must advise patients about the risks associated with opioids. They must also advise patients about their ability to have the prescription filled for a lesser quantity of pills.
The law states Schedule II controlled substances, such as hydrocodone and oxycodone, may not be prescribed for more than 30 days, unless certain criteria are met. These restrictions do not apply to cancer patients, hospice patients, patients receiving palliative care, or a patient in a long-term care facility.
Patients receiving medications for the treatment of substance use disorder or opioid dependence, such as methadone, are also exempt from the restrictions.
Under the law, any patient receiving a Schedule II prescription must have a physical examination every 90 days. Any prescription for more than seven days also requires a narcotics agreement with the prescriber, indicating they will only receive prescriptions for controlled substances from the prescribing practitioner and only fill their prescriptions at a single pharmacy.
The law also outlines criteria for subsequent opioid prescriptions. For example, if "the practitioner determines the prescription is necessary and appropriate to the patient's treatment needs" and the prescription "does not present an undue risk of abuse or addiction," a subsequent prescription can be issued. Practitioners again must discuss risks and alternatives for treatment.
Once a practitioner issues three subsequent prescriptions, he or she is encouraged to refer the patient to a pain specialist.
The law also establishes a "voluntary non-opioid directive form," in which patients can indicate they do not want to be administered or prescribed an opioid. The advance directive will be filed in the individual's medical record, and transferred with the individual from one practitioner to another.
As for alternative therapies for pain, the law requires insurance providers who offer insurance products in the state, at a minimum, to provide coverage for 20 visits for physical therapy, occupational therapy and other pain management services.
The law will go into effect in June.
(c)2018 The Register-Herald (Beckley, W.Va.)