Ducey Opioid Plan Aims To Restrict Prescribing, Protect Arizona Patients
Jay Fleming knows what life is like without his pain medication. He tried it not that long ago.
“I’d hobble around the house hanging on to furniture to try and get around,” Fleming said. “It really affected my quality of life.”
Fleming, a former police officer, lives in the remote, outer reaches of northwest Arizona with his wife and their family of dobermans. He’s been taking opioids for decades ever since a failed back surgery for a herniated disc.
This trial run of getting off the medication, he said, confirmed just how much he still depends on it.
“Most people use them to get out and do things. They don’t sit home and get high,” he said. “It’s their freedom.”
Fleming sees a pain specialist regularly. His prescriptions are tracked and he’s drug tested.
But as alarm over the opioid crisis grows louder, Fleming fears those suffering from chronic pain who have been on opioids for years could become collateral damage.
“I am afraid they are going to restrict them too much. You can only go to a pharmacy and be treated like a drug addict, by your pharmacy, by everyone who knows you take that kind of medicine,” Fleming said. “You can only deal with that stuff so long.”
It's one of the central challenges policymakers face as they get to work crafting new laws to address the epidemic of opioid abuse and overdose deaths — how to protect legitimate patients while still getting tough on overprescribing?
Governor Ducey's New Plan
This week, Gov. Doug Ducey called the Arizona legislature into special session to pass a slew of laws aimed at everything from expanding treatment to reducing the supply of pills.
“A lot of work has gone into this. And the result is one of the most thorough, thoughtful and aggressive pieces of public policy we have seen in years," Ducey said. “We will maintain access for chronic pain sufferers and others relying on these drugs."
Ducey’s plan already has the backing of the state’s Democratic and Republican leadership, but it’s still unclear how much pushback will come from doctors and their patients.
In a letter to the state last year, the Arizona Medical Association and Arizona Osteopathic Association expressed concerns about restricting prescribing too much, saying that could hamstring doctors with complex patients.
“One of the things we don’t want to do is get in between the doctor-patient relationship,” said Republican Representative Regina Cobb of Kingman.
Cobb, who is vice chair of the House health committee, said more regulations are necessary, but she thinks they must be targeted and based on accurate data.
Cobb is a practicing dentist and knows these challenges firsthand. She recently received her report card from Arizona’s controlled substance monitoring program, a database providers must use every time they prescribe.
“Not all this is accurate,” Cobb said. “I know what mine is. It says it is higher than what I have done. So rushing through legislation without knowing we are correct is going to be difficult to do.”
New prescribing rules are a significant part of the governor’s plan. It would restrict the first fill of opioids for patients who have never taken them to five days’ worth and end paper prescriptions. Most doctors would also be prohibited from dispensing opioids on-site and above 90 morphine milligram equivalent (MME), a level at which federal guidelines recommend extreme caution when prescribing.
“I think there need to be some things addressed. I just don’t want to be going too far. What I have seen from the proposals is that it’s mainly directing at limiting the doctors,” Cobb said. “That’s not all the problem.”
State numbers show heroin was involved in overdoses just as much as oxycodone in the past six months.
The governor’s plan would set aside $10 million for treatment and establish a 911 Good Samaritan law to protect people from prosecution who call to report an overdose.
Senator David Bradley, a Democrat from Tucson, said it’s unfortunate that doctors will have to deal with more rules, “but unfortunately when someone in your profession does something like this, everyone suffers.”
“My response is too bad,” Bradley said. “If it becomes burdensome and people are suffering, we don’t want that to happen and over time we could make adjustments.”
A Focus On Prevention
Dr. Cara Christ, director of the Arizona Department of Health Services, said the proposed regulations are focused on prevention, which is why patients with prescriptions right now would not be affected by them.
“We are not tapering them down,” Christ said, “because we understand we don’t want to push people to illicit unregulated drugs.”
Christ said the state has worked extensively with the medical community to design prescribing guidelines and that doctors will still have the flexibility to treat patients who need the medicine. There would be exceptions for trauma, cancer and hospice patients, among others, and pain specialists would not be subject to the rules.
“We are not trying to limit responsible use of the medication. We just want to try to prevent people from developing a lifelong chronic disease,” Christ said, referring to substance use disorder.
Since June — when the governor declared a public health emergency — about 40 percent of those who overdosed in Arizona had nine or more prescriptions filled in the past year. Chronic pain was also the most common pre existing medical condition for those who overdosed.
Christ said such findings show the need for more oversight.
“We completely understand there is a majority of physicians that are acting responsibly and we want them to still have the tools that they need to treat their patients,” she said. “It’s really the prescribers who are overprescribing to make a profit and are just not using reasonable care.”
The number of prescriptions in Arizona has been going down gradually in recent months, but Christ said it will take years before Arizona sees the true effect of its prevention efforts.