As a nation, we’ve made some progress in combating the opioid epidemic in the past few years, but that progress has come with a price. Strict federal guidelines on prescribing opiates, stringent state laws to enforce monitoring and prescribing regulations, and increased federal support for identifying, prosecuting, and convicting individuals who allegedly contribute to the prescription opioid epidemic have resulted in a tense, challenging environment for doctors and their patients who suffer with chronic and, in some cases, acute pain.
In this blog post, I will explore this environment, focusing on the effects of the latest opioid guidelines and laws on doctors and their vulnerable patients.
The C.D.C. Opiate Prescription Guidelines and Care for Patients with Severe Chronic Pain
According to a recent letter sent to the Centers for Disease Control and Prevention from over 300 medical experts, patients with severe chronic pain are not getting the medication they need to lead quality lives. As a result, some patients who formerly had prescriptions for opioids have turned to buying them illegally on the street or using heroin.
The letter writers, including professors of addiction medicine, pain specialists, patient representatives, and the former drug czars from the Obama, Clinton and Nixon administrations, note that the C.D.C.’s opiate prescription guidelines, published three years ago, have been misused by insurers, legislatures, and governmental regulatory bodies. Consequently, patients who need pain medication are not getting treated effectively and those who have been on it for a long time are losing their effective treatment. Testimonials from hundreds of pain patients submitted with the letter to the C.D.C. attest to their daily suffering in the current pain treatment environment.
With quality patient care in mind, the letter writers ask that the C.D.C. make it clear that doctors are the ones who should be in charge of decisions about how to treat their pain patients.
Florida’s Laws on Controlled Substance Prescribing
Many state legislatures have not left doctors in charge of pain treatment decisions. Instead, they have used the C.D.C.’s non-binding standards as the basis for binding regulations and laws on controlled substance prescribing. The National Conference of State Legislatures reports that as of October 2018, at least 33 states had passed legislation limiting opioid prescriptions.
Florida’s Reporting Requirements
Indeed, Florida has passed some of the most stringent legislation in the country. In 2009, the state passed legislation requiring pharmacists and dispensing practitioners to report prescriptions for controlled substances to the prescription drug monitoring program (PDMP) database within seven days. This was followed in 2011 with legislation requiring that all physicians and other healthcare practitioners who prescribe any controlled substance to treat their patients’ chronic nonmalignant pain designate themselves as a controlled substance prescribing practitioner in their professional profiles and adhere to standards of practice established by law. Pain management clinics also have to register with the Department of Health and follow numerous state regulations.
In 2018, the Florida state legislature strengthened the existing laws on prescribing controlled substances, increasing the challenges doctors face in caring for and reporting on pain patients. A new requirement, for example, makes it mandatory for prescribing physicians or dispensers (or their designees) to check a patient’s controlled substance history in the Electronic-Florida Online Reporting of Controlled Substances Evaluation Program (E-FORCSE) database before prescribing or dispensing a controlled substance to a patient who is 16 years old or older. If the database can’t be accessed at the time, the prescriber or dispenser can only prescribe or dispense at the most, a three-day supply and must document the reason why the database wasn’t consulted.
Under this 2018 law, many healthcare practitioners have to use the state’s prescription drug monitoring database for the first time. If they prescribe or dispense a controlled substance without consulting the database, they will be issued a non-disciplinary citation by the Department of Health. Subsequent offenses can lead to discipline from their respective boards, and a practitioner who intentionally doesn’t report dispensing a controlled substance will be charged with a misdemeanor of the first degree.
Florida’s Prescription Limits
The 2018 statute also establishes new, strict limits for prescribing controlled substances for treating “acute pain.” According to the law, a prescription for a Schedule II opioid for the treatment of acute pain cannot be for more than three days except in the case of cancer, a terminal condition, palliative care for an incurable illness or injury, or a severe traumatic injury.
Patients who suffer from other injuries or who have major surgery cannot be given more than a three-day prescription for a controlled substance to treat their pain, despite what their doctor thinks they need. They can only be given more (up to a seven-day supply) if their prescriber writes “ACUTE PAIN EXCEPTION” on the prescription and documents the reason in medical records.
Challenges for Florida Doctors and Their Patients
As states have enacted increasingly stringent legislation to enforce monitoring and prescribing regulations, patients have suffered. Many with chronic nonmalignant pain have been forced to accept lower doses of medication that do not effectively manage their pain, or they’ve been taken off their pain medication altogether.
Doctors and other healthcare providers have had to deal with increased monitoring and reporting requirements as well as restrictions on their ability to treat their patients’ pain.
The requirements and regulations are especially restrictive in Florida, one of only three states with a three-day limit on controlled substance prescriptions for treating acute pain.
In addition, as law enforcement agencies have intensified their efforts to prosecute doctors, clinic owners, pharmacists, and patients suspected of being involved in illegally dispensing and distributing prescription medications, many practitioners and clinics have come under investigation. Even if you’re following the new laws, something in the state database or some other alleged evidence could trigger a state or federal investigation.
If you are being investigated by the state or federal government, please get help from an experienced federal defense attorney as soon as possible. At the Jonathan Rose law firm, we focus on defending “pill mill” and healthcare fraud cases. I have over 20 years of experience as a trial attorney and the expertise you need to develop a strong, comprehensive defense strategy to protect your rights, freedom, and future.
Hoffman, J., & Goodnough, A. (2019, March 6). Good news: Opioid prescribing fell. The bad? Pain patients suffer, doctors say. The New York Times. http://www.nytimes.com/2019/03/06/health/opioids-pain
National Conference of State Legislatures. (2018). Prescribing policies: States confront opioid overdose epidemic. http://www.ncsl.org
Scott, J. (2018, Spring). Florida’s new law on controlled substance prescribing. Florida Medical Magazine. http://www.FLmedical.org
Whitmore, R., & Whisenant, D. (2019, Feb. 5). Opioid prescribing limits across the states. Pharmacy Times. https://www.pharmacytimes.com