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    The Other Side of Opioid Limits

    Proponents argue that limits reduce the risk of addiction, but are they keeping pharmacists from caring for their patients?


    As the opioid crisis worsens, pharmacies, pharmaceutical manufacturers, and legislators are scrambling to help solve the problem. Recently, those efforts have focused on limiting opioid supplies. But in the effort to prevent unnecessary medications, are pain patients getting left behind?

    Several major players in the pharmaceutical world have recently voiced their support for opioid limits. Express Scripts and CVS Caremark (CVS’s PBM) recently announced a seven-day supply limit, and PhRMA, the association representing pharmaceutical manufacturers, announced at a meeting of the President’s Commission on Combating Drug Addiction and the Opioid Crisis that it also supported a seven-day limit. The DEA recently announced that it is advocating for a 20% reduction in opioid production next year, which could affect the supply of available opioids.

    Related article: Limits on Opioid Prescriptions Gain Popularity

    Most opioid limits are based on CDC guidelines released in March 2016, guidelines based on a review of available evidence and expert opinions. The recommendations cover patients facing long-term chronic pain (pain lasting more than three months), but not active cancer treatment, palliative care, or end-of-life care. The CDC recommends that clinicians prescribe immediate-release opioids instead of extended-release opioids, and avoid going over 90 MME/day. The guidelines say that three days or fewer of opioid supply “will often be sufficient” for acute pain, and that supplies for more than seven days “will rarely be needed.” However, the report does stipulate that “patients should receive appropriate pain treatment based on a careful consideration of the benefits and risks of treatment options.”

    A spokesperson for PhRMA said that, while still needing to stay consistent with state guidelines, certain criteria conditions would “clearly” meet exemptions, such as cancer pain and hospice and palliative care.

    Pharmacy Groups Debate

    Overall, pharmacy groups seem supportive of the effort, but wary of its implementation.

    Chad Clinton, an APhA spokesperson, told Drug Topics that APhA is “generally supportive of the CDC Guideline, which are recommendations intended to drive safer prescribing for chronic pain patients, and are not suggested for active cancer treatment, palliative care, and end-of-life care, and efforts to address our nation’s opioid epidemic.”

    Related article: Are states going too far with painkiller script limits?

    However, Clinton said that APhA has “concerns that payer decisions are a one-size fits all approach and will supplant providers’ clinical decision-making and the needs of patients who have legitimate need for these medications.” He added that payer limits restrict patients with legitimate pain management needs from accessing opioids. Those limitations, he said, will force patients not at risk of abuse or misuse to work with their prescriber and pharmacist—which will cost the health-care system and “significantly” impact patients with limited resources, physical restrictions, or transportation issues. He also added that more research still needs to be done on the impact these rules will have medications for legitimate patients.

    As for how they will affect pharmacists, Clinton said that “APhA is concerned pharmacists and other providers will have additional administrative burdens due to the need to navigate these limitations on behalf of our patients in order for them to obtain the medications they legitimately need.”

    Up next: More pharmacy groups weigh in


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