Michigan Introduces Legislation Targeting Opioid Overprescribing

On November 10, 2016, Michigan State Representatives Driskell, Darany, Dianda, Geiss, Chirkun, Chang, and Robinson introduced House Bill (HB) 6045, which would amend the Michigan Public Health Code to provide restrictions on the quantity of prescription opioid medications that can be issued by a prescriber under certain circumstances. This legislation comes on the heels of recent efforts by the CDC to raise awareness and hopefully curtail the growing opioid epidemic.

HB 6045 would place a 7-day supply limit for prescribers issuing an opioid prescription to an adult patient for the first time. Additionally, a prescriber would not be able to issue an opioid prescription to a minor for more than a 7-day supply. The legislation also requires that the prescriber discuss the risks associated with opiate use with the parent or guardian of the minor prior to issuing the prescription. These limitations will not apply to a prescription drug issued for the treatment of substance abuse or opiate dependency.

The legislation does supply an exception for providers who feel that a greater number of days’ supply is medically necessary under most conditions, including:

• The treatment of an acute medical condition
• Chronic pain management
• Pain associated with a cancer diagnosis, or
• Palliative care

At this point, you might be asking yourself, “If these exceptions to the rule exist, how is this different from current practice?” The answer is that prescribers taking advantage of this part of the law must document the indication for the treatment in the patient’s medical record and attest that non-opiate alternatives are inappropriate for the treatment of this condition in the judgement of the prescriber. By requiring this documentation, the law has the potential to increase prescriber accountability and reinforce the seriousness of prescribing opioid medications.

The 7-day treatment restriction appears consistent with certain portions of the CDC Guideline for Prescribing Opioids for Chronic Pain, released on March 18, 2016. The guidelines state that “long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.” The research cited under this recommendation includes the American College of Emergency Physicians Opioid Guideline Writing Panel’s clinical policy, which recommends prescribing quantities less than or equal to 7-day supplies of opiate medications for acute pain from emergency departments.

The CDC has, more recently, called on pharmacists to be working on the issue of opioid abuse and overdose “on the front lines” in a brochure that was release this past October. This online document notes that sales of prescription opioids in the United States has “nearly quadrupled from 1999 to 2014,” and notes that this has done little to put a dent in the number of Americans who report issues with pain. The brochure goes on to provide suggestions for partnering with prescribers and communicating with patients that facilitate a team approach to addressing the opioid problem.

The legislation introduced in Michigan and the national education efforts on the part of the CDC are part of the ongoing effort to curb this growing public health crisis. Numerous regulatory and policy approaches related to opiate abuse and overdose are being considered by the Michigan legislature as part of the taskforce convened by Governor Rick Snyder to address problems related to opioid abuse and misuse. We can reasonably expect that these topics will continue to be part of the conversation as the 2015-2016 legislative session comes to a close and we move forward into the new legislative session beginning in 2017.