On Sept. 26, Gov. Rick Scott announced that he would ask the Florida Legislature for a $50 million budget to fight opioid addiction and misuse in Florida.
“I am proud to announce that I will propose major legislation during the upcoming legislative session and more than $50 million in my recommended budget to combat opioid abuse in our state,” Scott said in a press release.
Many applauded Scott’s plans, which would help fund substance abuse treatment, recovery support and the Florida Violent Crime and Drug Control Council. But parts of his proposal drew fierce backlash.
The governor recommended a three-day limit on most opioid prescriptions and a severe restriction on seven-day prescriptions. Pain-relieving opioids, such as oxycodone and codeine, have a high potential for dependency and addiction.
The Centers for Disease Control and Prevention guidelines on opioid prescriptions say that “three days or less will often be sufficient” for treating short-term pain, and “more than seven days will rarely be needed.”
Critics of placing limits on opioid prescriptions often argue that the regulations are unfair to individuals living in chronic pain.
Although there is no evidence that opioids are safe or effective for long-term pain management, the drugs are regularly prescribed to people experiencing pain lasting more than three months. Neither Scott nor his office announced the conditions necessary to allow opioids to be prescribed for seven days.
But the governor announced several other changes intended to combat opioid misuse:
- Require all health professionals who prescribe or dispense medication to participate in the state’s prescription drug monitoring program.
- Require physicians to take continuing education courses on responsible opioid prescribing.
- Enact reforms to combat unlicensed pain management clinics.
- Create new opportunities to receive federal funding.
“These proposals will make a major impact on limiting the chance of drug addiction, reducing the ability for dangerous drugs to spread in our communities, giving vulnerable Floridians the support they need, and ensuring our hardworking law enforcement officers have the resources to protect Floridians,” Scott said.
Florida’s Attorney General Pam Bondi, Senate President Joe Negron and House Speaker Richard Corcoran praised Scott’s leadership on the issue. The legislative representatives didn’t indicate whether they expected to approve the proposal, but they said they looked forward to working with the governor.
Limits to Duration of Opioid Prescriptions
Maine became one of the first states to regulate opioid prescriptions in 2017. The state now forbids physicians from prescribing more than 100 morphine milligram equivalents per day to most patients. Those receiving end-of-life care, cancer treatment and treatment for other specified conditions are exempt from the rule.
Morphine is the standard that other opioids are judged against. One milligram of morphine is equivalent to 1 milligram of hydrocodone, 1.5 milligrams of oxycodone or 3 milligrams of oxymorphone, according to the CDC.
In a CDC report, the agency said that patients who are prescribed higher dosages of opioids face an increased risk of dying from overdose. Those taking a dosage at or above 50 morphine milligram equivalents per day are at least two times more likely to overdose than patients taking less than 20 morphine milligram equivalents per day.
Less than a week before Gov. Scott’s announcement, CVS Health announced a new opioid management program that will limit the amount of opioids its pharmacies can dispense.
Details of the program included:
- Creating seven-day limits to opioid prescriptions for patients new to opioid therapy
- Establishing daily dosage limits based on the strength of the prescribed opioid
- Requiring patients to try immediate-release opioids before extended-release opioids are dispensed
The new opioid management program is expected to affect individuals with commercial, employer-based and Medicaid insurance plans. It will go into effect on Feb. 1, 2018.
“As America’s front door to health care with a presence in nearly 10,000 communities across the country, we see firsthand the impact of the alarming and rapidly growing epidemic of opioid addiction and misuse,” Larry J. Merlo, president and CEO of CVS Health, said in a press release.
Advocates for responsible opioid prescribing praised the move as more than a public relations stunt, but critics said the pharmacy was disrupting the relationship between patients and physicians. Those against the new requirement said prescription decisions should be made by physicians, not pharmacists.
Scott Proposal Follows Declaration of Public Health Emergency
In May, Scott declared the opioid crisis a public health emergency in the state of Florida. The 60-day declaration allowed the state to receive $27 million in federal funds this year to prevent and treat opioid misuse and addiction. Scott extended the declaration for another 60 days in July.
On Aug. 28, the day the declaration was set to expire, Florida Sen. Jack Latvala wrote the governor to request another extension.
“There have been reports that suggest 14 Floridians have died every day in the first half of this year due to opioids, which is higher than the number of Floridians we have lost per day at the height of the pill mill crisis,” Latvala wrote. “If this trend continues, by the time the Legislature passes a budget in March 2018, over 2,700 more Floridians could die.”
Hours later, Scott extended the public health emergency. The governor signed a bill earlier this year to stiffen sentences for people trafficking fentanyl in the state. He and Bondi also announced plans to reduce the cost of naloxone for law enforcement. Naloxone is a medication that can reverse the effects of an opioid overdose.