Debate Over Limiting Opioid Prescriptions to Five-Day Supply

NJ Spotlight News | February 2, 2017 | Health Care, Politics
Not all agree with limiting opioid prescriptions to a five-day supply for acute pain.

By Michael Hill

The reality lawmakers face in trying to get the upper hand on New Jersey’s addiction crisis.

“Sixty percent of our patients are coming in with an addiction to opioids. I would tell you probably a majority — 80 to 90 percent — start in the medicine cabinet,” said Donald Parker, president and CEO of Carrier Clinic.

There’s overwhelming consensus that over-prescribing and easy access to opiates have fueled the heroin epidemic. But, the head of the Carrier Clinic disagrees with the governor and the Assembly speaker in limiting initial opiate prescriptions to a five-day supply for acute pain.

“It is an individual decision by a doctor that gets the appropriate amount of medication to a patient,” Parker said.

“When you have four out of five heroin users started on opioids, that’s something we have to make sure that we curtail how people get them,” said Assembly Speaker Vincent Prieto.

The prescription limit is in a package of measures responding to the epidemic, a package speeding its way through committee hearings to the full Senate and Assembly.

“Oh, we’re very excited about this bill. Not only does it limit opiate prescriptions to five days, it requires a conversation between the physician, or dentist and the patient and that patient can be any age,” said Angelo Valente, executive director for Partnership for a Drug-Free New Jersey.

The bill also would require doctors to get better in continuing education about prescribing opioids. Among its bipartisan sponsors — Assemblyman and medical doctor Herb Conaway, routinely criticized for blocking a prescription limit as chair of the Health and Senior Services Committee. Advocates say he’s the reason the governor bypassed lawmakers and directed the state attorney general to come up with new rules to limit opiate prescriptions, limits that start Feb. 16. Limits Conaway still seems to oppose.

“My position is the government doesn’t practice medicine. People expect to go to the doctor and that their particular needs are going to be met by a physician, not by some government mandate on speech or other sort of government practice of medicine,” he said.

But Conaway supports other parts of the bill such as requiring insurance carriers to cover the first six months of in-patient or out-patient treatment. He sees challenges ahead, if the governor and lawmakers don’t get rid of the “red tape” preventing treatment.

“And this whole system of appeals is one way medical necessity is one way of denying care. The other way is an appeals process that is so onerous that nobody wants to participate in it,” Conaway said.

In written testimony, the trade group for the insurance industry raised concerns the bill would prioritize in-patient care over more effective, less costly treatment options.

Assemblyman Robert Auth — who owns an insurance business — echoed that in questioning a witness in a hearing.

“Is there a threat of creating a financial situation for insurance companies that will make them leave the state or discontinue business in a particular region as a result of this?” he asked.

“I think as a nation, we’re at a very interesting point when it comes to health care. If we are talking about insurance and money — insurance at the base of it is a financial animal. It exists not to pay claims, but to make money,” said Frank Jones, founder of Recovery Reform Now.

Frank Jones is a partner with Mints Insurance but says he doesn’t represent the industry. He just launched Recovery Reform Now to remove access barriers to treatment.

“It is abhorrent what the insurance carriers have been able to do, for many, many years. Operating out of compliance with the parity laws and forcing people to fail first,” he said.

The bill has encountered some realities of the marketplace such as — as some lawmakers point out — most of those seeking treatment lack health insurance and would rely on Medicaid, which falls outside the bill’s scope. Another reality: if approved, the bill would only apply to state-regulated insurers or about 30 percent of the marketplace. Nevertheless, lawmakers see what they’re doing as knocking down barriers to treatment.

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