Vermont Governor Peter Shumlin and state Health Commissioner Harry Chen recently announced proposed changes to the Health Department’s rules that would severely restrict the prescribing of opioids for pain. Much of the outgoing governor’s tenure has been devoted to countering the heroin and opioid crisis.
Governor Shumlin calls opioid addiction the biggest health crisis in the nation. He puts FDA approval of high-powered opiates at the root of the country’s opiate and heroin addiction crisis. He has called over-prescribing the drugs the primary challenge. During his state of the state, he called on his health department to limit distribution of the drugs. The department has now issued proposed changes that the governor says would put Vermont at the leading edge of curbing doctors’ “irrational exuberance” to prescribe opiates. “We have proposed rules for minor procedures you will be able to get 10 to 12 pills before you have to go back to your prescriber. I think it’s the most restrictive program in the country. It will help us to move more people away from addiction in the first place.”
During legislative discussions Health Commissioner Dr. Harry Chen was tasked with determining how to limit opioid prescriptions. “Vermont specific data shows that in 2015 we prescribed enough opioids to provide every man, woman and child with a bottle of 100 pills of oxycodone. And that’s data from our Prescription Monitoring System. We know that most post-operative patients who go home after surgery only use half of their pills. We also know that one single prescription, contrary to what we were told in the 1990’s, can actually lead to addiction, overdose and even death.”
Dr. Chen says the stricter rules will eliminate doctors’ use of opioids. “We want to make sure that that the first thing they try are not opioids. We know from the literature that one ibuprofen and one acetaminophen is as good as 3 oxycodones.”
The proposed rules use severity and expected duration of pain to determine the limits for opioid-based prescriptions. Commissioner Chen explained that limits will be higher for more complicated procedures but will be capped at a 7-day supply. “For minor procedures I think the first thing is no opioids. Use over the counter ibuprofen and acetaminophen. If that doesn’t work then a small prescription of somewhere between zero and three days which can come up to 12 pills or so. For more major procedures we’ve gone up through 5 days worth of medications again with strength of medications related to the kinds of procedures that they undergo. And then finally an outside limit of seven days at the maximum regardless of whatever procedures there are.”
The Health Department collaborated with the medical community to craft the prescription protocols. University of Vermont Medical Center Director of the Family Medicine Service Dr. Patty Fischer says new respect is needed for the powerful and addictive medications and the new rules provide that structure. “I hope it will remind prescribers of what the best practices are, what conversations they should be having with patients. I hope that this rule will result in fewer opiates being prescribed for all injuries and procedures and earlier detection and referral to those developing a substance abuse disorder.”
The rules will be finalized in December.