The national discussion of opioid-related issues can resemble a pendulum. It swings to a focus on the sincere needs of patients suffering with excruciating chronic pain. It then swings to address the desperate pleas of communities and families who have tragically lost loved ones to drug abuse and addiction.
The victims deserve more than a pendulum-approach to policymaking and publicity.
They deserve a comprehensive approach to a complex dilemma, that — at the same time — addresses everyone’s needs.
Viewed in its own right, the recently re-introduced John S. McCain Opioid Addiction Prevention Act (S. 724/H.R. 1614) reflects simultaneous allegiance to patients with chronic or ongoing pain, to patients with acute or temporary pain who may be at risk of addiction and eventual overdose, to children and others who may find excess opioid medications and abuse them and to those who care for these individuals.
The bill would limit the supply of a patient’s first opioid prescription to seven days, when that prescription is for acute pain such as that caused by an injury. The bill does not limit a prescriber’s ability to prescribe alternative pain-management therapies. Nor does the bill in any way limit the treatment of chronic, or ongoing, pain, or of pain related to cancer, illness, or end-of-life — an essential point that must be emphasized.
Regarding opioid prescriptions for acute pain, the Centers for Disease Control and Prevention (CDC) advises that “three days or less will often be sufficient; more than seven days will rarely be needed.” CDC findings also caution that the chance of long-term opioid use increases after the first three days of use — and rises severely with each additional day.
An over-supply of opioids also can affect a patient’s loved ones, as over half of abused prescription pain medications are obtained from family and friends. The Mayo Clinic found that nearly one-third of patients used none of the opioids they were prescribed after surgery and only eight percent disposed of the medications.
The John S. McCain Opioid Addiction Prevention Act essentially would establish a “safety” mechanism for the use of opioids in the management of acute pain, yet it would not prevent a doctor or other prescriber from issuing another prescription, after the first one, to address a patient’s unique experience and needs.
Viewed in the context of other initiatives — such as the SUPPORT for Patients and Communities Act enacted last year — the bill stands as another crucial piece of the comprehensive solution on which Congress should act.
To be clear, much of the nation’s drug abuse, addiction and overdose crisis relates to illegally made and trafficked fentanyl and heroin. It is a credit to law enforcement, to researchers, to thought leaders, to policymakers and to the media who have helped to raise awareness of this fact.
Nobody claims that the John S. McCain Opioid Addiction and Prevention Act is sufficient to address every aspect of drug abuse, addiction and overdose — no law has that magic power. Yet it is a necessary component of this critical pursuit.
Pharmacies’ recommendations on complex public policy issues reflect their unique experience on the front lines of healthcare delivery. There is a moment of truth when a patient arrives at the pharmacy counter to pick up an opioid prescription and pharmacists must exercise their “corresponding responsibility” — which federal regulations place on them — to assess whether prescriptions for controlled substances are written for a legitimate medical purpose.
Based on the full range of pharmacists’ experiences on these issues, NACDS has recommended a series of public policy recommendations. These include mandatory electronic prescribing for controlled substances — which was addressed for Medicare in last year’s SUPPORT for Patients and Communities Act. These also include the seven-day initial supply limits for acute care contemplated in The John S. McCain Opioid Addiction Prevention Act, as well as policies related to technology-based prescription drug monitoring plans and to drug disposal.
These policy recommendations complement pharmacies’ long-standing and ongoing initiatives in the areas of compliance programs, advancing e-prescribing, drug disposal, patient education, security initiatives, fostering access to overdose antidotes, stopping illegal online drug sellers and rogue clinics and more.
Americans respect pharmacies’ perspective. By a two-to-one margin, pharmacies and pharmacists are considered more as part of the solution to the opioid abuse epidemic than as part of the problem of opioid abuse, which approaches the level of esteem afforded to law enforcement on these issues. That is according to a January 2019 national survey of registered voters conducted by Morning Consult and commissioned by NACDS.
In that survey, six-in-10 supported the concept of limiting an initial opioid prescription to seven days as a way to reduce the likelihood that a patient becomes addicted and to reduce the number of opioids in the public domain. Only 2-in-10 opposed it, with others not expressing an opinion.
At the pharmacy counter and in the halls of Congress, pharmacies advocate simultaneously for patient care and for opioid-abuse solutions. Pharmacists work every day to make those objectives compatible and thus have a helpful perspective to share with policymakers as they work to do the same.
From that perspective, it is time to pass and enact the John S. McCain Opioid Addiction Prevention Act.