The John S. McCain Opioid Addiction and Prevention Act

ETA: The Disability Justice Initiative tweeted today this: "Props to @SenGillibrand staff for sitting down & listening to members of the #disability community today. We look forward to continuing the #PainManagement conversation in a way that limits misuse without harming the #disability & #ChronicPain communities."  

Senator Gillibrand received some strong negative pushback when she announced support of "The John S. McCain Opioid Addiction and Prevention Act"  (he sponsored it, thus the name, but such naming is tedious -- how could anyone oppose something named that?).  She got so much pushback (and not just on Twitter) that she felt it necessary to respond.  Not surprising when people cited it as simply disqualifying (anyone who did so was not really too gung ho for her anyway, I would argue).

[One person responded to a comment I made about it by saying it would likely "kill" friends of his.  Yeah.  Tad overheated there. I can say that since (unlike my Twitter and blog comments some places) no one actually reads this blog. Reading into the law, including my own state's policy, how exactly will this proposal "kill" people above and beyond current practice?]

What is the problem here?  Looking at the summary, we are told that  the "bill would create a seven-day prescription limit for opioids so that no more than a seven-day supply may be prescribed to a patient at one time for acute pain."  The term "acute" received some pushback since the inference from references to wisdom tooth removal and the like was that it was something that would be completed in seven days.  This suggests the limits of official Twitter snapshots of proposals, perhaps.  Anyway:

Acute pain is a type of pain that typically lasts less than 3 to 6 months, or pain that is directly related to soft tissue damage such as a sprained ankle or a paper cut.  Acute pain is of short duration but it gradually resolves as the injured tissues heal. Acute pain is distinct from chronic pain and is relatively more sharp and severe.

That is just a quick find but gets to the open-ended nature of the term.  But, the summary of the provision (contra to one Twitter reply that I myself replied to without getting a response)  says that the person still can obtain more supply.*  Gillibrand cites her own state as a model of the law, something reply after reply seemed to skip over, and I looked it up.  Yes:

TO FURTHER REDUCE OVERPRESCRIBING OF OPIOID MEDICATIONS, EFFECTIVE JULY 22, 2016, INITIAL OPIOID PRESCRIBING FOR ACUTE PAIN IS LIMITED TO A 7 DAY SUPPLY.

A practitioner may not initially prescribe more than a 7-day supply of an opioid medication for acute pain. Acute pain is defined as pain, whether resulting from disease, accidental or intentional trauma, or other cause, that the practitioner reasonably expects to last only a short period of time. This rule SHALL NOT include prescribing for chronic pain, pain being treated as a part of cancer care, hospice or other end-of-life care, or pain being treated as part of palliative care practices. Upon any subsequent consultations for the same pain, the practitioner may issue, in accordance with existing rules and regulations, any appropriate renewal, refill, or new prescription for an opioid.

The proviso regarding chronic pain is also said by Gillibrand to apply here in some form (we don't get a link to the actual bill though given McCain supported it, some form of it should be around, right?). New York provides a FAQ.  One question specifically answered says that it is not necessarily the case that an in person visit is necessary to obtain a refill. This was an important concern. If a physician would otherwise supply a greater supply, would they not also extend without an additional visit?  The concern seems to be that many would be wary.  Thus, an essential issue here is detail.

Gillibrand voiced surprise at the opposition in part since she did not just make this up on the fly. It was looked at askance that she was co-sponsoring this with a Republican though one that from time to time comes off as sane.  As noted in the reply:

I wrote this bill in consultation with many experts and groups, including researchers, advocates, doctors, patients, and families of patients. It was based on CDC recommendations — and reflects a movement across the nation in which 15 states, including New York, already have laws that limit opioid prescriptions for acute pain.

One thing highlighted by the speakers at her rally yesterday is that she listens. I respect supporters who say this about her and take this seriously:

I have heard this level of criticism, and many of the concerns raised by patients and disability advocates were issues I had not previously heard. And I hear them now. ...

I am listening. I would be more than happy to meet with you to hear your ideas about how to make this bill better — and to ensure that it does what it was originally intended to do without harming patients. 

The proposal might simply be misguided. Perhaps, we should simply trust physicians here and that this is an unnecessary attempt to show she is properly fighting opiate addiction.  The breadth of "acute" pain alone suggests a certain gratuitous nature in requiring weekly prescriptions, even if merely by phone or whatnot. But, without more, even then, it seems a limited misstep. I respect those who are concerned that this will make it harder for people who need pain medication. This is not a trivial matter and it's part of a serious wider concern. Nonetheless, any number of policy tweaks have possible negative effects. Is this unique?  A reason not to support her?

Anyway, I do wonder how much it compares to my own state's policy. It turns out my own assemblywoman is on the Standing Committee on Alcoholism and Drug Abuse.  I am curious if she has an opinion of this proposal and if it overlaps with state policy. I sent an email to her but have not received a response.  It is granted that I could call up her office and this on me to some extent but if the office has a means to constant, they should be able to respond. Also, the questions are of a sort of detailed quality that the likely aide in her district office very well might not be able to answer.  Yes, I feel uncomfortable personally asking such things too. Kudos for those who do so.

I will try to continue to keep abreast on this issue. Doing a bit of due diligence like done here is not too hard and can be helpful.

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* The coverage might confuse people. One publication noted that the requirement covers "the initial treatment of acute pain" but then "medical professionals would have to confirm they would not provide refills to those prescribed opioids for acute pain." 

I take this to mean that each seven day supply is separate so not a "refill" but perhaps a person can read that to mean it is a one and done deal. Serial weekly supplies amount to a form of "refill" even if by form the doctor (without needing a new examination) gives a new script each time.