By Ken Breda
Director of Pharmacy, Brookshire Brothers
President, Texas Federation of Drug Stores
Every day, pharmacists serve patients suffering tragically with chronic pain. They also see first-hand the ravages of addiction, including dependence on legitimate opioids and on similar drugs that are made and sold illegally.
With experience on the front lines of healthcare delivery, pharmacists also know viable public policy solutions when they present themselves. We see a tremendous opportunity right now in the Texas Legislature to help solve the opioid abuse epidemic, while remaining sensitive to those suffering with chronic pain.
Senator Lois Kolkhorst, who chairs the Senate Committee on Health and Human Services, and Rep. John Zerwas, M.D., deserve credit for crafting a bill (HB 2174) that would prove effective in addressing abuse and addiction related to legitimate opioids.
Among other steps, the bill would limit the supply of a patient’s first opioid prescription to 10 days, when that prescription is for temporary, or acute, pain. It is crucial to point out, this limit does not apply to ongoing, or chronic, pain. It does not apply to cancer care, to treatment of other illnesses, nor to end-of-life care. The bill also would require electronic prescribing for controlled substances, to help prevent fraud and abuse.
The supply limit will help to reduce the chances that a patient will become addicted to opioids. In fact, prescribing guidelines by the Centers for Disease Control (CDC) and Prevention note that patients are more likely to use opioids on a long-term basis, increasing the risk of addiction, if they remain on opioids more than three days, and the risk increases significantly after each additional day. CDC also states that a three days’-or-less supply of opioids will often be sufficient to treat temporary, or acute, pain, and that more than seven days will rarely be needed.
Both the supply limit and the electronic prescribing requirement will help to prevent opioids from falling into the wrong hands. Electronic prescribing helps to prevent fraudulent prescriptions, and the diversion of prescription opioids. The supply limit makes it less likely that patients keep a large number of pills within easy reach of children and other family members, after their treatment is over. A study by the Mayo Clinic determined that about one-in-three patients did not use any of the opioids prescribed for them after surgery, and these opioids were disposed of properly only eight percent of the time.
Regarding HB 2174, Texas Attorney General Ken Paxton characterized the bill as a “crucial tool in the fight against opioid abuse, which would significantly reduce initial opioid addiction and also prevent most fraudulent prescriptions of opioids.” Attorney General Paxton has been a national leader in the fight against opioid abuse, and said HB 2174 “will have an immediate positive impact on families through reduced opioid abuse in Texas.”
A poll conducted by Morning Consult, and commissioned by the National Association of Chain Drug Stores, found that eight-in-ten Texas voters either support the seven-day supply limit and the electronic prescribing requirement, or do not have an opinion on the issue. Six-in-ten support the measures outright, and opposition is extremely low at two-in-ten.
Based on daily engagement with patients across Texas, based on our ongoing collaboration with law-enforcement, and based on pharmacists’ extensive education and experience, we know this legislation would help protect Texans, and would start doing so as soon as it went into effect.
