Editorial: Florida needs to cap days that patients are put on opioids

It’s good to see Florida leaders join the growing trend toward limiting prescriptions for opioid painkillers.

Last week, Gov. Rick Scott said he’ll ask lawmakers to impose a three-day limit on opioid prescriptions. A day later, Palm Beach County State Attorney Dave Aronberg announced he’ll seek a five-day limit when the Legislature convenes in January, a proposal hatched by the county’s Sober Home Task Force before it learned of Scott’s stricter idea. Aronberg heads the task force.

Whether the cut-off ultimately proves to be five days or three days, a measure like this is long overdue. Heroin and heroin-related deaths continue to surge in Florida. According to the latest available figures, 805 people died in Florida from fentanyl in the first half of 2016, more than double the toll in the first half of 2015; and 434 from heroin, a 25 percent hike.

And Palm Beach County, home of South Florida’s sober-home industry, is tragically leading the body count: 163 deaths from fentanyl and 97 from heroin, the most of any Florida Medical Examiner District.

This squalid crisis all too often has its beginnings in the respectable offices of a trusted doctor. Seventy-five percent of new heroin addicts say they started with prescription drugs. So says the U.S. Centers for Disease Control and Prevention (CDC).

“What we’ve said to doctors is to remember that any single one of those prescriptions could ruin or end a patient’s life,” then CDC director Dr. Tom Frieden told a conference last year. “Prescription drugs are now gateway drugs.”

Research is showing that the number of days of someone’s first opioid prescription has a huge impact on their long-term use. A recent CDC study found that opioid prescriptions longer than five days in length significantly increased the likelihood of opioid use up to three years later.

Researchers at the University of Arkansas for Medical Science in Little Rock found that increased risk of addiction starts in as little as three days. “The days supplied for the first opioid prescription is the strongest predictor of continued opioid use,” their paper says.

The conclusion of the project’s chief author: write scripts for fewer days.

“You are going to have fewer persons becoming long-term users,” said Bradley Martin, a professor of pharmacy.

At least 11 states, from Arizona to Maine, are doing just that, with most settling on a limit of seven days for initial opioid prescriptions. (Kentucky set the cap at three days.) The CVS pharmacy chain last month said it will limit opioid prescriptions to seven days for certain conditions. On the federal level, Sens. John McCain, R-Ariz., and Kirsten Gillibrand, D-N.Y., have introduced legislation to limit an initial prescription of opioids for acute pain to seven days.

These measures won’t come without problems. Some patients will surely endure more pain if the cutoff is too strict. Some may run into insurance problems.

These considerations will complicate legislation, but shouldn’t kill it. The reality is, America is awash in opioids. The nation consumes more doses than 24 other countries surveyed by the United Nations. In a National Safety Council survey last year, 23 percent of doctors said they prescribe at least a month’s worth of opioids — when evidence shows that 30-day use causes brain changes.

Such wanton distribution of opioid painkillers, besides provoking the possibility of more addictions, is even questionable as good medicine. According to the CDC, over-the-counter drugs ibuprofen and acetaminophen, as well as exercise, weight loss and anti-depression medicines, should be prescribed before opioids are.

“Any management, if it is going to be successful, needs to be proactive, not reactive, and needs to have multiple facets, including education and guidelines,” Norman Tomaka, a Melbourne pharmacist, told Drug Topics magazine recently.

Florida lawmakers quietly killed a bill this year that would have capped initial opioid prescriptions at five days. They simply must do better in the coming session. Opioid addiction is at intolerable levels. And while we must do many things to attack the crisis, the most basic is to lessen the opportunities for people to become addicted in the first place.

A squalid crisis that too often begins in the respectable offices of a trusted doctor.

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