Bill would limit new opioid prescriptions to seven-day supplies

Arielle Levin Becker :: CTMirror.org

Sue Kruczek, wearing her son Nick’s memorial hockey jersey, speaks in favor of a bill to cap the supply of opioid prescriptions. Nick died at age 20 of a heroin overdose after initially taking prescription opioids.

New prescriptions for opioid medication to address non-chronic pain would be limited to a seven-day supply under a proposal state legislators from both parties are backing – one of several bills aimed at curbing a drug epidemic that killed, on average, more than one person per day in Connecticut last year.

“A lot needs to be done,” said Rep. Prasad Srinivasan, R-Glastonbury, who said it’s common to hear about patients receiving a month’s supply of opioid painkillers and not knowing what to do with all the pills they don’t need. And Rep. Sean Scanlon, D-Guilford, cited federal data showing that more than half of those who misuse prescription painkillers got them from a friend or relative.

The proposal, which the Public Health Committee voted to move forward Monday, would impose a seven-day limit on first-time opioid prescriptions to address non-chronic pain in adults, although patients could subsequently get refills. Minors would be limited to a seven-day supply without the possibility of refills – with some exceptions, legislators said – and any provider who prescribes them would have to discuss the risks associated with opioids with the minor’s parent or guardian.

The bill includes an exception for cases in which the prescribing practitioner determines that a longer supply is needed to address a patient’s acute medical condition, chronic pain, pain associated with cancer or for palliative care. In those cases, the prescriber would be required to indicate in the patient’s medical record that an alternative to the opioid drug was not appropriate.

Legislators from both parties, a physician who studies prescription drug abuse, and a mother whose son died of a drug overdose, described the measure as a way to keep people from becoming addicted to opioids, to reduce the availability of extra pills that others could use to feed their addictions, and to make it easier for doctors to find a balance between treating patients’ pain and avoiding drug misuse.

Srinivasan, a physician and the top GOP House member on the Public Health Committee, acknowledged that more work needs to be done on the bill, including to address the possibility that patients receiving repeat seven-day prescriptions would have to pay a separate copayment each time, rather than one if they had received a 30-day prescription.

The growth of heroin addiction, much of it rooted in prescription painkillers, has drawn significant attention from lawmakers this session. Gov. Dannel P. Malloy’s administration proposed expanding access to naloxone and other drugs that can reverse the effects of opioid overdoses by requiring municipalities to ensure their emergency medical services providers are equipped with opioid antagonists and that their staff receive training on how to administer them. It also would allow licensed health care professionals to administer them without facing liability.

Lawmakers are also working with the Malloy administration on a separate portion of the seven-day prescription bill that would allow pharmacists to administer naloxone or other opioid antagonists with a standing order.

A separate proposal would require health insurance plans to cover abuse-deterrent opioid medications and prohibit insurers from requiring that customers first use one that is not abuse-deterrent.

The seven-day prescription limit proposal follows the release of guidelines for opioid prescribing last week by the U.S. Centers for Disease Control and Prevention, which recommended, among other things, that prescriptions for opioids in cases of acute pain be limited to the quantity needed for the expected length of pain severe enough to require the drugs. “Three days or less will often be sufficient; more than seven days will rarely be needed,” the guidelines say.

Rep. Matt Ritter, co-chair of the Public Health Committee, said legislators considered limiting prescriptions to three days, but opted against it in response to concerns that a patient who had surgery on a Wednesday could run out over the weekend and, since getting more requires an in-person visit, could struggle to get more if needed.

According to the Centers for Disease Control and Prevention, more than 165,000 people died from overdoses related to opioid pain medication from 1999 to 2014, and the death rate associated with the drugs has increased substantially over the past decade, even while death rates from heart disease and cancer have declined.

Opioid-related deaths have also surged in Connecticut. In 2015, more than 60 percent of the state’s 723 overdose deaths involved opioids.

Legislators touted the bill during a press conference with a framed photograph of a young man in front of the podium. It was Nick Kruczek, who died of a heroin overdose in 2013. His mother, Sue, said her son first received an oxycodone pill from a hockey teammate when he was 14. “He later told us he never skated a high school game sober,” she said, wearing a memorial hockey jersey with her son’s name on it.

At 19, Nick told his mother he needed to go to rehab. He later took classes at Southern Connecticut State University and got a job and an apartment. But 11 days before his 21^st birthday, Nick didn’t call or text his mother – rare for him – and Sue Kruczek went to check on him. She found him dead.

Although Nick had never been prescribed an opioid, Kruczek said her son’s addiction was nonetheless the result of overprescribing, because someone else’s excess pills allowed her son to get the drugs while in high school.

Dr. Daniel Tobin, a professor at the Yale School of Medicine who studies chronic pain management, prescription drug abuse and opioid safety, said there are two competing epidemics: addiction and drug misuse, and pain.

“It can be really hard to sit across from a patient who’s in pain and say, ‘No, this is not safe for you,’” Tobin said, adding that the bill could be a way to empower doctors to find a balance in treating pain while also considering the drawbacks of opioids and potentially recommending patients take a break from the medication.

Kenneth Ferrucci, senior vice president for government affairs at the Connecticut State Medical Society, said after the press conference that he hadn’t yet seen the bill’s language. “We just want to be certain we’re not hampering the ability of physicians to treat their patients,” he said.

And Ferrucci said it was important that whatever policies come out of this session address the disease of addiction, not just the symptoms. That means having more treatment beds, more facilities, coverage for medication-assisted treatment and educating the public on signs of addiction.

Malloy spokesman Devon Puglia said the administration is working closely with the committee co-chairs on the issue and will be reviewing the bill.