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Thread: New Jersey to Limit Amount of Opioid Pills in Prescriptions to five-day max supply

  1. #1
    Senior Member NW-Will's Avatar
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    New Jersey to Limit Amount of Opioid Pills in Prescriptions to five-day max supply

    https://www.wsj.com/articles/new-jer...ons-1487198253



    ByKATE KING
    Updated Feb. 15, 2017 6:01 p.m. ET4 COMMENTS

    New Jersey Gov. Chris Christie signed legislation Wednesday curtailing the quantity of opioid pills doctors can prescribe for acute pain, a restriction he said is necessary to curb the state?s addiction crisis.
    The new law lowers the limit on initial prescriptions for opioids to a maximum five-day supply from 30 days for acute pain and directs practitioners to prescribe the lowest effective dose of immediate-release opioid drugs. Mr. Christie, a Republican, has pledged to spend his final year as governor battling the state?s heroin and opioid epidemic.



    ?This is not something that?s going to turn around overnight because of what we?ve done today,? Mr. Christie said after signing the bill in Trenton. ?Addiction treatment is a process. We?re starting down a road that may take us five to 10 years to really see marked results that are consistent. But we?ve got to start the journey.?
    As part of the bill, state-regulated health-care plans are required to provide unlimited benefits for in-network addiction treatment for 180 days without prior authorization. If services at a facility that is in the insurer?s network aren?t immediately available, network exceptions must be provided to ensure admission within 24 hours.

    In his annual state address last month, Mr. Christie called for lawmakers to pass the new mandates within 30 days and pledged to sign the legislation the day it landed on his desk. The bill arrived 36 days later, after passing a final vote in the state?s lower chamber Wednesday afternoon.
    The bill received wide bipartisan support, with 97 lawmakers voting in favor of the legislation, one opposing it and 12 abstaining.
    Medical professionals had opposed the bill?s provision limiting opioid prescriptions, saying it risked harming patients with legitimate pain-management needs. The law?s opioid prescription limitations don?t apply to cancer patients, people in hospice or residents of long-term care facilities.
    Medical Society of New Jersey Chief Executive Larry Downs said many patients recovering from upper torso surgeries such as mastectomies need pain medication to heal. Requiring patients to return to a doctor?s office after five days would be unfairly burdensome.
    ?People need to breathe and move after surgery in order to get their systems functioning and make sure they don?t get pneumonia,? Mr. Downs said. ?In many cases, that?s not a five-day issue.?
    Despite its criticism of the limits on prescriptions, the Medical Society of New Jersey testified before lawmakers in favor of the overall bill because of its other provisions expanding insurance coverage for addiction treatment.
    ?Doctors recognize that there?s a huge addiction issue in this state and in this country that needs to be addressed,? Mr. Downs said.
    The law?s new insurance mandates affect a minority of New Jersey residents, applying only to those covered by state-regulated, individual and small-employer plans. They don?t apply to self-funded plans, such as those offered by most large companies, nor will they affect Medicaid or Medicare.
    The New Jersey Association of Health Plans, a nonprofit association, didn?t take a position on the legislation. President Wardell Sanders said he expects the law?s insurance mandates to have ?a significant impact in cost, although it?s hard to measure. We?re not aware of any state that?s done anything quite like this.?
    Mr. Christie said the costs are difficult to calculate because it is unclear how many people will take advantage of the expanded access to treatment.
    ?Whatever the cost is of this, it?s certainly less than 1,600 lives a year,? he said, referring to the number of New Jersey residents who died from fatal overdoses in 2015. ?I?m not someone who does mandates lightly. But we have no choice but to do this and to do this the right way.?


    Stephen Crystal, a Rutgers University professor who specializes in health-services research, said the efficacy of the new insurance mandates is unclear because many in need of opioid-addiction treatment are uninsured or are receiving Medicaid or Medicare.
    ?I think it?s a very good step, but it?s only a partial solution to the problem,? Mr. Crystal said.
    Corrections & Amplifications
    An estimated 1,600 New Jersey residents died of fatal overdoses in 2015. An earlier version of this article incorrectly stated 2016. (Feb. 15, 2017)

    Write to Kate King at Kate.King@wsj.com

  2. #2
    Emergency Rooms and Urgent Care centers here already limit to a 3 or 5 day supply of controlled medications.

    I wouldn't want to have elective outpatient surgery or be discharged from a hospital after surgery on a Thursday-Friday. Run out of medications by Monday-Tuesday and have to wait to hear back from the doctors office and Pharmacy.

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    Senior Member beecee's Avatar
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    I love my doc
    100 - 10/325 per month
    take as needed for pain

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    Senior Member Vintage's Avatar
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    ...so, a spinal cord injury person jumps through hoops to get out of the hospital, out of the nursing home, and get back to her own home where she will change her own diapers, cook, and transfer alone back and forth from her bed...only to find that access to opioids for her pain are now limited because she isn't in a long-term care facility.
    The law?s opioid prescription limitations don?t apply to cancer patients, people in hospice or residents of long-term care facilities.
    Female, T9 incomplete

  5. #5
    So this law actually has a lot of research behind it. I'm all for it. From what we understand after years of studying opioids pain medications is that they are really good for acute pain for a few days. Kind of.

    long term, opiod medications cause a decrease in your pain threshold. Thus if you have chronic back pain 8/10 on the pain scale and never take opiates you will continue to have 8/10 pain. If the same person were to be given long term prescription for opiates their pain would initially be less when taking the pain meds but soon (a week or two) their pain would be 8/10 when they had the drug in their system and 10/10 when it was wearing off.

    This is a real physiologic phenomenon that isn't well understood, but in another anesthesiology paper they gave patients opiate medications intraoperatively so the patient wasn't aware whether or not they got the medications. Turns out a one time dose of intraoperative pain medication means you have more pain post op.

    So if you're gonna prescribe long term opiates, for them to be effective you have to increase the dose regularly and steadily. This cancer patients and hospice patients both of whom are presumed to have a relatively short time left make sense to give these increasingly large doses of pain meds to.

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    For acute pain, this probably makes some sense. I know when I had surgery, I would be given a 7-day prescription and would only use a few days of it. I'm on opiods for chronic pain now. They are really the only things that have worked - an believe me, I have tried everything. My doctor told me that here in Ohio, opoids are topped out at 80 mg/day - based on morphine dose. My insurance pays for 180 pills over 30 days. Currently, I am using a combination of 800 mg, 3x per day of gabepentin and up to 20 mg per day of dilaudid. Most days I use the full amount alotted. I don't want to, but without it my pain skyrockets.

  7. #7
    Quote Originally Posted by MikeRobison View Post
    For acute pain, this probably makes some sense. I know when I had surgery, I would be given a 7-day prescription and would only use a few days of it. I'm on opiods for chronic pain now. They are really the only things that have worked - an believe me, I have tried everything. My doctor told me that here in Ohio, opoids are topped out at 80 mg/day - based on morphine dose. My insurance pays for 180 pills over 30 days. Currently, I am using a combination of 800 mg, 3x per day of gabepentin and up to 20 mg per day of dilaudid. Most days I use the full amount alotted. I don't want to, but without it my pain skyrockets.
    damn, that probably got you high in the beginning... where is your pain if I may ask, I currently switched from hydro to oxycodone for shoulder pain
    C5/C6 Complete since 08/22/09

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    Senior Member Tim C.'s Avatar
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    Wow, 7 days for new scripts only I assume.
    My Roxy renewals are 30 day, with 90 day mandatory visits .

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    In the hospital I know I hallucinated, but was on IV meds then. But today, they have few side effects - except for constipation.

  10. #10
    i am so tired of hearong about this media opiod epedimic, there are way too many people that need opiods for pain and the laws are making them into demons. A bunch of white kids die and something has to be done.
    cauda equina

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