By Cindy Coloma
The opioid crisis has raised many questions in the media and within the medical field, but recently, it’s also caused a shift in the ways companies provide patient access to prescriptions.
In previous years, if we experienced a medical or dental issue, Americans expected a supply of pain medication to help us cope with the pain, and often those medications were opioids. From surgeries to injuries to chronic pain, pain medications seemed to be prescribed without hesitation, and many times, in excess. However, these days of broad or unlimited supplies of opioids appear to be coming to an end.
Crisis Creates Change in Protocol
The opioid crisis in the United States has been headline news for quite some time. President Trump declared it a public health emergency in October 2017.1 The CDC reports that opioids killed 42,000 people in the United States in 2016. That number is staggering, considering those numbers were five times higher in 2016 than they were in 1999.2
Leaders in law enforcement, government and healthcare have been scrambling for solutions to turn the tide. This has led some physicians and pharmacies to re-evaluate their prescribing protocols. In February 2018, drugstore chain CVS, which manages medications for nearly 90 million plan members in the United States, made headlines when they announced that they would limit opioid prescriptions to seven days.3 This was just the beginning.
Walmart Takes Action
In May 2018, Walmart, the fourth-largest pharmacy chain in the US, made waves when it announced new restrictions on how it will fill opioid prescriptions within Sam’s Club and Walmart pharmacies. The retail giant declared that, like CVS, they would limit prescribed acute painkillers to cover a maximum of only seven days. Walmart also plans to limit a single-day’s dose to no more than the equivalent of 50 morphine milligrams, and it will abide by state laws where more stringent policies regarding opioid prescriptions have been implemented. The new Walmart prescription opioid policy will be fully enforced by the end of the summer 2018.4
Walmart’s recent policy states they are making an effort to be part of the solution to America’s opioid epidemic, and this move aligns with the overall trend towards regulation of opioids in America.5
Should Opioid Prescriptions Be Limited?
To some, it may seem extreme to limit medications that are prescribed to a patient by their personal physician. Shouldn’t a doctor be allowed to create a plan of care based on a patient’s medical need? There are valid points and opinions on each side of the fence.
The US Food and Drug Administration’s commissioner, Scott Gottlieb, MD, believes that action to limit opioid prescriptions should have been taken years ago. “The type of action we need to take to finally (address) this crisis is going to be far more dramatic than we would have had to do had we made certain decisions years ago,” said Dr. Gottlieb.6 His agency supports opioid prescription limits.
Others are cautious about limiting prescription decisions for physicians. Patrice A. Harris, MD, MA, 2018 president-elect of the American Medical Association, and chair of their Opioid Task Force, is concerned that the new policies may have the potential to negatively impact many patients who rely on their doctors to regulate their pain. “When patients seek physician help for an opioid-use disorder, or need comprehensive care for chronic pain, one-size-fits-all limits, such as blanket prior authorization protocols, may cause delays in care that could severely harm patients,” she said.1
Besides health concerns such as risky withdrawal and resurgence of debilitating pain, opponents of the new limits also fear that doctors, already overwhelmed with paperwork and red tape, may stop prescribing opioids altogether.7
It remains to be seen whether the new regulations regarding opioid prescriptions will turn the tide and cause a decrease in overdose and addiction disorder. The reality is, at this time, many patients will not have the same access to opioid pain medication that they have been accustomed to over the years. This could affect individuals and families on many levels, but it will take years to understand the overall long-term results of these policies.
1 Merica, Dan. “Trump Declare Opioid Epidemic a Public Health Emergency,”cnn.com, October 26, 2017.
2 “Prescription Opioid Overdose Data”, Centers for Disease Control and Prevention, Accessed May 26, 2018.
3 Scutti, Susan and Kounang, Nadia, “CVS Will Limit Opioid Prescriptions To 7 Days”, CNN, Accessed May 28, 2018.
4 Romo, Vanessa, “Walmart Will Implement New Opioid Prescription Limits By End Of Summer”, Jefferson Public Radio, Accessed May 28, 2018.
6 O’Donnell, Jayne, “FDA Chief Supports Opioid Prescription Limits, Regrets Agency’s Prior Inaction”, USA Today, October 23, 2017.
7 Hoffman, Jan, “Medicare Is Cracking Down on Opioids. Doctors Fear Pain Patients Will Suffer”, www.nytimes.com, March 27, 2018.