Doctors, Optometrists Battle Over Right to Write Hydrocodone Prescriptions

Andrew Kitchenman | December 10, 2014 | Health Care
Medical Society sees giving ability to prescribe dangerous drugs running counter to efforts to prevent addiction

eye chart optometrists
Some eye conditions — from serious infections to scrapes to the cornea — result in agonizing pain, and can send New Jerseyans on a trip to their optometrist. Optometrists evaluate the condition and until recently were able to prescribe hydrocodone, a powerful opioid pain reliever.

But in October, the U.S. Drug Enforcement Agency reclassified hydrocodone because of its addictive potential and increased the restrictions governing it, making it impossible for optometrists to prescribe the medication.

Now, a bill restoring this prerogative to optometrists in NJ has drawn opposition from the Medical Society of New Jersey, the state’s largest group representing physicians.

Medical society representatives argue that it’s appropriate to restrict the ability to prescribe opioids to medical doctors, citing ongoing state efforts to prevent and treat chemical dependence on this class of drugs. They also note that a newly approved form of hydrocodone increases the importance of restricting who can write prescriptions.

Advocates for optometrists, however, say that these specialists have an established history of safely prescribing hydrocodone; that optometrists are fully qualified and experienced in all eye treatments short of surgery; and that a better method for reducing addiction is to require all doctors to participate in the state program to track all opioid prescriptions. They’ve gained powerful allies in the Legislature, who reject the M.D.’s arguments as serving their own interests.

This is the latest chapter in a decades-long turf war between New Jersey’s doctors of optometry (O.D.’s) and opthalmologists, who are medical doctors (M.D.’s) or doctors of osteopathy (D.O.’s).

On October 7, the DEA reclassified hydrocodone as a schedule II controlled dangerous substance, the second-highest level of regulated drugs. Other opioids are in this category, but hydrocodone had previously been in the less-restricted schedule III, since it is less powerful. However, with the number of hydrocodone-addicted people rising, the DEA acted.

This move affected New Jersey optometrists because a 2004 state law allowed them to prescribe schedule III pain medication, but not schedule II. A newly proposed bill, S-2578/A-3922, allows them to continue to prescribe hydrocodone, but not other opioids. Ten other states have adopted similar bills.

Medical Society legislative affairs senior manager Mishael Azam said at a time when medical doctors are prescribing fewer opioids and taking continuing medical education classes on pain medication, it doesn’t make sense to keep giving optometrists the authority to prescribe hydrocodone.

The society “is also concerned that this bill benefits practitioners more than patients,” Azam wrote in a letter to legislators. She noted that the American Optometric Association has credited its own lobbying efforts with delaying the rescheduling of hydrocodone by two years.

Azam added that the introduction of the new hydrocodone-based medication Zohydro has increased the importance of the new restrictions. Zohydro is more powerful the other forms of hydrocodone, which were previously prescribed by optometrists. Azam noted that the Senate Health, Human Services and Senior Citizens Committee approved a resolution calling on the federal government to reconsider its approval for Zohydro — citing its potency — at the same time that the Senate Commerce Committee increased the range of healthcare providers who can prescribe it.

But Sen. Joseph F. Vitale (D-Middlesex) rejected the Medical Society’s contention that reauthorizing optometrists’ ability to prescribe the drug would harm addiction prevention efforts. He’s a sponsor of the optometrists’ prescription bill and the primary backer of a 21-bill package designed to improve state addiction prevention, treatment, education. and recovery programs.

Vitale noted that optometrists have a good track record of prescribing hydrocodone.

“Now, just because it’s been moved to schedule II doesn’t mean that they shouldn’t be able to continue to prescribe it, because they’ve been doing it safely,” Vitale said.

New Jersey Society of Optometric Physicians Executive Director Howard Cooper described the medical doctors’ opposition as “a smokescreen to prevent real reform.” He supports legislation that’s part of the 21-bill package that would require all prescribers to participate in the New Jersey Prescription Monitoring Program (PMP).

Cooper added that there’s no history of optometrists abusing their prescription authority.

“This bill is not an expansion of our prescriptive authority — we’ve done it safely and in accordance with the rules,” Cooper said, adding that it’s false to say the bill is contrary to addiction prevention. Cooper added that while Zohydro is strong, “this is just another hydrocodone product that is available to the medical community.”

He noted that the restrictions on schedule II drugs — including limits on the number of pills that can be prescribed at one time and a requirement that hard copies of prescriptions be given to pharmacies for refills — are intended to better control the drugs, not restrict access to patients who truly need them.

“Our interests are to provide the best possible care to our patients and if a patient comes in with the medical necessity that requires these medications, the patient is entitled to the best patient care that they can get from our practitioners,” he said.

The Senate Commerce Committee released the prescription bill in a bipartisan, 5-0 vote. The Assembly version of the measure has been referred to the Assembly Regulated Professions Committee.