Published in The Pilot: http://www.thepilot.com/new-opioid-law-changing-awareness-of-abuse/article_bc847b56-faef-11e7-8ac5-376aaaa4e256.html
As of the start of the year, doctors now find themselves having to abide by a new North Carolina law limiting the way they can issue opioid prescriptions.
The new state law limits prescriptions to a five-day supply for first-time acute pain patients, and a seven-day supply for post-surgical pain
This most recent regulation, known as the STOP Act, is designed to limit the number of excess pills in circulation that can potentially be diverted or stolen.
As the number of overdose deaths in the state have risen over the last few years, members of the medical community hope this law, along with others under the STOP Act, will help curb the death count.
Dr. Paul Kuzma, a pain management physician in Pinehurst, said the new law will make a positive impact but may initially prove challenging for doctors.
“There will definitely be annoyance, because it’s extra work and it’s not that easy to write a prescription,” he said. “So if you have a major operation — a knee replaced or shoulder operated on — it’s pretty certain you’re going to need more than a week’s worth of pain medication. For the surgeons, I think it’s going to be a burden on their offices because they might not be used to seeing a patient for two weeks.”
Moore Regional Addiction Specialist Dr. Greg Collins said the law is a relatively benign intervention with good intentions, although it’s conceivable that it could have unexpected consequences.
“I can envision situations where people can’t get back to the doctor. You know, transportation may be a problem, and their five days of medication runs out and they can’t get to the doctor or get an appointment. But I think if doctors are aware of it — and they undoubtedly will be — that they’ll probably make some accommodation for people to work into their schedule.”
Despite potential consequences, Collins said the benefits will outweigh any inconveniences, especially when considering that statistics show a third of all opiate medications are diverted. When given a month’s supply of pain pills, patients may only use a week’s worth, or less if they react poorly to opioids. Family members and friends can swipe unused medications, and it’s not uncommon for addicts to take extreme measures such as taking open-house tours to raid medicine cabinets for leftover pills, said Kuzma.
“That’s pretty ominous,” Collins said. “That’s horrible, because there are ten million prescriptions written in North Carolina every year, one for every man, woman, and child.”
For Narcotics Detective Sergeant Jesse Stubbs, the STOP Act as a whole has already helped lessen his heavy workload in Moore County. He predicts the law will continue to diminish narcotic theft and doctor shopping cases, which he said are fairly common in the area.
Stubbs said enacting the use of a state database, which doctors are required to check to see how many prescriptions patients have filled before handing them another, has already dropped the frequency of doctor shopping cases by 75 percent. But prescription fraud and heroin use has picked up.
“In states that already passed similar legislation, heroin use does pick up but addiction treatment picks up even more because going from prescription pills to heroin is a big jump,” Stubbs said. “A lot of people aren’t ready for it. There’s some people, when the pills stop coming in, they’re going to be so dope sick they probably will try heroin. But it’s a huge step to go from shooting a pill, or snorting a pill, to shooting heroin.”
Still, despite the improvements, more could be done in North Carolina to reverse the effects from years of overprescribing. Moore County’s prescribing rate is at 7.93 percent compared to the national rate of 5.74 percent, according to figures from the Centers for Disease Control.
Kuzma said this prescribing rate is due in some part to a shift in physicians’ attitudes to take their patients’ pain more seriously, and the heavy marketing of Oxycontin in the mid-90s. Collins attributes the high rate to the large elderly population and the proximity to Fort Bragg.
“Of the four major areas in North Carolina that have the biggest problems, three of them are near big military bases,” Collins said. “You have a lot of PTSD, a lot of wounded people, and that’s a real fertile ground for aggressive use of opiates. And I guess in the underworld drug industry, places that have relatively low levels of police activity are prime. They’re better places to do business, frankly.”
Kuzma said awareness of the issue began long before the STOP Act, and Moore Regional had been holding informational meetings on opioids prior to the passing of any laws or regulations. Stubbs also holds the opinion that tackling the issue earlier might have ebbed the overdose and death counts.
“I think it could have been done a lot earlier,” he said. “People in my position, who do what I do, most of us have been preaching the same thing for years. I feel like everyone is jumping on this thing now, while it’s starting to die.”
And there is room to improve. Kuzma said allocating more money and resources toward making the slow database system more efficient would be one enhancement. Expanding Medicaid to cover costs of non-opioid therapy and psychiatry treatments for addiction would also help patients, he said.
Now, with more national media attention and an action plan to reduce N.C. opioid overdose deaths by 20 percent by 2021, it looks as though the epidemic could be lightened. Though officials worry there is still danger that synthetic opioids, like fentanyl, will take the place of prescription opioids.
“No place is immune,” Collins said. “We like to think we’re a little paradise here, and we kind of are, but we’re not immune to these big city problems.”