New opioid legislation includes 3-day limit on initial prescriptions

A group of senators has introduced a new bill aimed at fighting opioid abuse and addiction, including limits on initial prescriptions for acute pain and an expanded role for non-physician practitioners in prescribing buprenorphine.

The legislation, being labeled as a successor to 2016’s Comprehensive Addiction and Recovery Act (CARA), would include $1 billion in new funding while also making several policy changes which could affect healthcare providers:

• Imposing a three-day limit on initial opioid prescriptions for acute pain, while exemptions for chronic care, cancer care, hospice or palliative care.
• Requiring physicians and pharmacists to use their state prescription drug monitoring program (PDMP).
• Requiring states to share their PDMP data.
• Permanently allowing physician assistants and nurse practitioners to prescribe buprenorphine under guidance from a qualified physician.
• Waiving the 100-patient cap limiting how many people a physician can treat with buprenorphine.
• Authorizing $300 million annually for expanding availability of naxalone to first responders and providing training on safety around fentanyl.
• Authorizing $300 million annually for expanding “evidence-based activities” for substance abuse treatment, including expanding medication-assisted treatment (MAT) and offering grants to state and local substance abuse agencies.
• Authorizing $200 million to better support people transitioning from treatment to long-term recovery.
• Increasing penalties for opioid manufacturers which “fail to report suspicious orders for opioids or fail to maintain effective controls against diversion of opioids.”

One of the bill’s sponsors, Sen. Rob Portman, R-Ohio, said in a speech on the Senate floor that he expects some to push back against the three-day prescription limit.

“This epidemic started with an explosion of pain pill use 15 to 20 years ago,” he said. “We need to stop the addiction at the source. For most people, that begins with prescription drugs. By ensuring clinicians prescribe the appropriate strength and supply of pain pills for non-life-threatening injuries, we can help stop so many more people from becoming addicted.”

Portman’s co-sponsors include Sens. Sheldon Whitehouse, D-Rhode Island; Shelley Moore Capito, R-West Virginia; Amy Klobuchar, D-Minnesota; Dan Sullivan, R-Alaska; Maggie Hassan, D-New Hampshire; Bill Cassidy, MD, R-Louisiana; and Maria Cantwell, D-Washington.

The bill didn’t include many of the suggestions made by the American Medical Association in a recent letter to the Senate Finance Committee. While CARA 2.0 does include expanded access to naxalone, it omitted many other AMA proposals related Medicare and Medicaid, such as requiring all Medicare Advantage Part and standalone Part D plans to covering MAT.