US Pharm. 2017;41(3):1.
Last month, shortly after a meeting on drug addiction with President Donald Trump at the White House, New Jersey Governor Chris Christie signed legislation approved by the state’s Democrat-led Assembly that was designed to head off the state’s opioid-addiction epidemic. The new law limits initial opioid prescriptions to a 5-day supply, making New Jersey’s limit the most stringent in the country, according to Governor Christie.
Several other states, including nearby New York, already impose limits, albeit longer ones (for example, 7 days), on the length of initial opioid prescriptions. The new legislation also requires that state-regulated health insurance companies cover inpatient and outpatient treatment for drug addiction.
The New Jersey measure is not all-encompassing, however. The prescription limit does not apply to patients treated for cancer and chronic pain or to end-of-life care. The legislation also calls for continuing education for professionals who prescribe opioid drugs.
Its apparent merits notwithstanding, the intent of the new New Jersey law appears to conflict with recent research on the likelihood of new opioid prescriptions progressing to addiction. Research presented by scientists from Brigham and Women’s Hospital and Harvard Medical School last fall at the 2016 Clinical Congress of the American College of Surgeons found that nearly three of four patients suffering a traumatic injury stop using opioids by 1 month after leaving the hospital.
Moreover, just 1% of these patients were still taking opioids such hydrocodone, oxycodone, morphine, and fentanyl a year later. (Rates of prescription painkiller use continued to fall to 3.9% at 6 months and to 1.1% after a year, the study points out.)
“We were really surprised by how low the numbers were for long-term opiate use,” said senior investigator Andrew Schoenfeld, MD. “It appears that traumatic injury is not a main driver for continued opioid use in patients who were not taking opioids prior to their injuries. Our findings in patients who sustain traumatic injury contradict the popular narrative about the role that appropriate use of opioids may play in the rate of opioid abuse in this country.”
An analysis of the findings, said the Brigham and Women’s Hospital and Harvard Medical School researchers, indicate that older age, from 45 to 64 years, was one of the factors increasing the risk of long-term use of opiates after an initial prescription. Other factors that predisposed patients to progress to longer opioid use included lower socioeconomic status and hospitalization longer than 2 weeks.
Understandably, the issue of opioid misuse and addiction remains volatile. “We are here today to save lives,” Governor Christie said while signing the bill in a State House ceremony. “New Jersey now leads the way first and foremost in recognizing this is a disease.”
Perhaps a more prudent approach than that undertaken by New Jersey would be for prescribers to exercise more discretion and employ evidence-based knowledge about addiction patterns rather than dictating opioid dosing schedules.
Research supports the argument that once the need for stronger pain medication is identified, the slippery slope to addiction may not be quite as steep as some would say. The real question is whether politicians should write the rules covering medical care, an area in which they have no training or experience. Many would say no.
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