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Arizona plan to combat opioids would limit dosages, amounts

Posted at 12:27 PM, Jan 19, 2018
and last updated 2018-01-19 17:57:37-05

Legislation being proposed by Arizona Gov. Doug Ducey to address the ongoing opioid crisis would bar doctors from prescribing more than an initial five-day supply of pain medication in most cases and limit the maximum dose they could prescribe to most chronic pain patients.

The governor's top health policy advisers, Christina Corieri and Department of Health Services Director Dr. Cara Christ, told reporters Friday that those limits and increasing regulation of pain clinics were key parts of the plan.

The governor's office didn't provide a copy of the actual proposal, saying it is still being revised even though they expect the Legislature to quickly enact the law in a special session to be called next week.

A draft of the legislation obtained by The Associated Press shows the limit on "first fills"  could require patients with chronic pain to see their physicians much more frequently. Ducey wants to limit the first prescription for "opioid-naive" patients to a five-day supply and 14 days for post-surgery patients. The draft bill says that limit would be triggered if a patient hasn't received a prescription in 60 days.

That means chronic pain patients would have to see their doctors every month or six weeks, rather than every three months as is common now, to maintain their long-term supply of pain relief drugs. That could boost their costs.

Corieri said that's not the intent of the legislation, and promised the final version would reflect that its goal is not to limit longer-term prescriptions for chronic pain patients.

"The intent is if you have had a script that covered any part of that past 60 days that you would not be subjected to that," Corieri said.

Chris said the goal is to avoid future addictions and she promised the final legislation would make that clear.

"If there is no opioid dispensed, taken, with the last 60 days, you want to make sure you're doing everything you can to avoid their risk of becoming depending or needing long-term risk of opioids," Christ said. "For those on long-term use, this is not designed to impact them."

The Republican governor has said he wants to protect people with chronic pain while trying to cut the number of new addictions. He declared an opioid emergency in June and the state Health Services Department put in place real-time overdose reporting rules. Between June 15 and Dec. 28, 2017, the department tracked more than 4,900 suspected overdoses and 716 suspected deaths.

Other details contained in the plan outlined Friday include a requirement that doctors use electronic prescriptions to cut down on forgeries, criminal penalties for manufacturers who fraudulently market their products and a ban on doctors, dentists, physician assistants and other prescribers from dispensing the drugs in their offices.

The law would also require all doctors who prescribe narcotics to take three hours of continuing training on opioids every other year. That would be included in their required 40 hours of training.

The bill also includes a "good Samaritan" provision that bars prosecution of someone who seeks help for an overdose victim if they're discovered with drugs as a result. Similarly, an overdose victim can't be prosecuted for drug possession when they call for help.

The limit on maximum doses is designed to prevent overdoses. The limit is expressed in morphine medical equivalents, and anyone getting more than 90 MME per day would have to meet certain criteria or be seen by pain specialists. Current patients would be exempt. Doctors would have to prescribe an opioid antidote along with the pain medications to those patients.

Not included in the bill is a requirement to slowly decrease high dosages, a plan which was opposed by the associations representing medical and osteopathic doctors in the state. They sent a letter to the governor in December outlining objections to several provisions, especially any set maximum limit or required tapering off of dosages.

"Every patient is unique and there is no universally accepted threshold for what is acceptable for every situation," the letter said. "Some complex pain patients can be properly cared for and managed by appropriate providers with higher dosages that allow them to manage pain and be active members of society and our economy."

The governor's plan also adds $10 million in funding to pay for treatment for people who don't qualify for the state's Medicaid program. The state program spent $236 million on addiction treatment in the last budget year. It also provisions boosting treatment referrals for overdose victims and expands a program in Phoenix that helps people get treatment to all 15 counties.