Efforts to Control Distribution of Rx Drugs

(Fall 2016) The White House Office of National Drug Control Policy (ONDCP) recently spoke about the U.S. opioid epidemic, placing the responsibility on both drug companies and physicians. An ONDCP official stated that the crux of the problem is a combination of the over-prescribing of pain medications by doctors combined with the physicians’ lack of education about addiction. Additionally, the ONDCP official stated that drug companies must be aware of the impact of their opiate advertising.

Health insurance company Aetna is taking a proactive stance on over-prescribing by making 951 specialists who prescribe opioids at higher rates than their colleagues aware of this tendency. Aetna’s data emerged from an investigation of over 8.6 million insurance claims. Physicians, such as oncologists, who typically write a lot of opioid prescriptions were not included in the analysis. According to Aetna, if the practitioners who received the notification (comprising the top 1% of U.S. prescribers) lower their rate of opioid refills to average levels, the number of pills distributed would be cut by 1.4 million.

At the other end of the spectrum, there is a vocal group of physicians speaking out against new state legislation that caps opioid prescriptions. Medical organizations, including the American Medical Association (AMA), argue that practitioners and their patients should be able to consider the requirement for pain management against the possibility of addiction.

This pushback comes at a time when many states have passed laws to lower the number of painkiller prescriptions written annually. A handful of states have outlined the maximum number of pills that can initially be prescribed to a patient, and 29 states have boosted prescription monitoring efforts to curb “doctor shopping” for additional opioids. Other states have set limits on prescriptions for minor injuries and procedures to a one-week supply.

The Centers for Disease Control and Prevention (CDC) issued draft guidelines late last year for doctors who prescribe opioid drugs. On the heels of the CDC’s recommendation, Massachusetts Governor Charlie Baker introduced a required three-day limit for patients initially being prescribed opioids. Although Massachusetts legislators were against the original proposal, they did pass a measure restricting first-time opioid prescriptions to seven days. Comparable laws have been passed in four additional states this year.

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