Vermont Proposal Would Set Opioid Prescription Limits

 Vermont Proposal Would Set Opioid Prescription Limits

Burlington, Vermont – Gov. Peter Shumlin and Health Commissioner Harry Chen, MD today announced proposed changes to the Health Department's rule governing the prescribing of opioids for pain. When finalized in December 2016, the amended rule will, for the first time ever, give guidance to prescribers and set legal limits on the dosage and number of opioid painkillers that may be prescribed. For some minor procedures, the proposal calls for a limit of between nine and 12 pills. 

“Vermont, and the rest of America, will not get a handle on the opiate and heroin addiction crisis until we confront head on the source of the problem: F.D.A. approved opiates that are handed out like candy,” Gov. Shumlin said. “Vermont doctors and providers have been on the leading edge of curbing the irrational exuberance with which opiates are handed out. These proposed limits will solidify that progress and help Vermont continue to lead the nation when it comes to combatting this crisis.”

  

The proposed limits come after Gov. Shumlin identified the over prescription of opiates as a primary challenge in tackling the addiction crisis in America. In his 2016 State of the State Address, the Governor called F.D.A. approval of high-powered opiates the “match that ignited America’s opiate and heroin addiction crisis". The Governor pointed to the fact that in 2010, enough OxyContin was prescribed to keep every adult in America high for an entire month. By 2012, enough prescriptions were written to give every American adult their own personal bottle of pills.

Studies have shown there is a wide variety in prescribing habits among medical professions and even
within the same practices. Many patients are prescribed twice as much medication as they need, often leaving the leftovers in medicine cabinets available for misuse, abuse and diversion.

"Opioids are powerful and useful pain killers, but they are powerfully addictive," said Dr. Chen. "We must flip the presumption that a patient needs opioids to manage pain. The rule allows doctors to make decisions with their patients, while requiring them to consider other treatments before opioids are prescribed, rather than as a last resort. And when opioids are prescribed, they can be prescribed for as much as a patient needs – but not more than they need."

The Health Department proposal uses severity and expected duration of pain to determine limits for the prescription of opioids. After a minor procedure that results in moderate pain, for example, a provider would be limited to prescribing between nine and 12 opioid painkiller pills (depending on the type of medication). The limits are higher for more complicated procedures, but no more than a seven-day supply limit would apply to all opioid prescriptions. There are exemptions for treating severe pain due to multi-system trauma or major procedures, like back surgery.

The proposal also requires providers to discuss risks, provide a patient education sheet, and receive an informed consent for all first opioid prescriptions. It requires a co-prescription of the overdose reversal treatment naloxone for all prescriptions over a specific strength, as well as opioids co-prescribed with benzodiazepines.

 "I believe prescribers will welcome the new rules, because they provide much needed structure to guide appropriate prescribing for pain," said Patricia Fisher, MD, medical director for case management and medical staff affairs at the University of Vermont Medical Center. "This will help us have meaningful conversations with patients about just how dangerous these medications can be, and help reduce excessive prescribing and variability that goes on now – with one doctor being more lenient in prescribing, and another more restrictive, and patients not understanding why.”

The Governor also announced today that Vermont’s prescription drug monitoring system is now sharing data with the bordering states of New York, Massachusetts, Connecticut, and New Hampshire, strengthening Vermont’s ability to prevent the diversion of opiate medications and identify individuals in need of intervention or treatment sooner.

In drafting the rule, the Health Department hosted 19 meetings and conference calls with various providers and stakeholders including physicians, pharmacists and dentists from around the state and around the country. A public hearing will be held on October 21 in at the Health Department, Room 3B, 1:00-2:00 pm in Burlington. Public comment is being taken until Oct. 28 at: AHS.VDHRules@vermont.gov.