Senate Health Committee Chairman Lamar Alexander (R-TN) is offering drafts of two pieces of legislation aimed at addressing the opioid crisis.
One measure would attempt to limit overprescribing by allowing the FDA to require drug manufacturers to package certain opioids in blister packs, which would allow for a set dose, such as a seven-day supply.
Rather than restrict the number of days on opioid prescriptions, Dr. James Madara, CEO of the American Medical Association (AMA), wrote a letter to Congress this month suggesting further research “that specifically identifies best practices in settings ranging from surgical to the emergency department.” The American Dental Association does back seven-day limits.
Alexander said the first draft legislation would “make it simpler for doctors to write prescriptions for smaller numbers of opioids” while reducing the risk of overprescribing. The plan also calls for manufacturers “to provide a safe way” to dispose of leftover drugs and packaging.
“If a mom receives a 30-day opioid supply after knee surgery, but only takes 15 days’ worth, this would make it easier for her to safely dispose of the unneeded opioids to prevent her child from finding them and using the remaining opioids,” Alexander said.
The CDC has guidelines on opioids that urges providers “prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.”
The American Dental Association on Monday came out in favor of a seven-day limit on dentists' opioid prescriptions. The group also supports mandatory continuing education on opioid prescribing.
Alexander’s other proposal involves improved coordination between the FDA and Customs Border Protection. The bill would look to improve the ability to find and seize illegal drugs, such as fentanyl, at the border. It would seek to ensure the two agencies have the technology, facilities and staffing needed.
The proposals aren't the only ones on Capitol Hill looking to reduce the length of opioid prescriptions. A bipartisan bill called the CARA Act 2.0 would limit initial opioid prescriptions to three days.
While the bills aim to limit the length of prescriptions, the AMA said more research is needed on the topic of prescription length. The length of prescriptions can vary depending on the situation.
Madara wrote that a Journal of the American Medical Association study found that “optimal opioid prescribing rates differed by type of general surgery procedure, ranging from a median of four days for general surgery procedures, four days for women’s health procedures and six days for musculoskeletal procedures. The study also found that prescription lengths associated with the lowest requirement for refill were nine days for general surgery, 13 days for women’s health and 15 days for musculoskeletal procedures.”
President Donald Trump offered his own proposal this month, including $13 billion to combat the crisis. The administration also launched CrisisNextDoor.gov to highlight the problem and allow people to share their stories. The president additionally wants to get tougher on drug dealers.
Meanwhile, states are taking action. This month, Florida implemented a law that limits most opioid prescriptions to three days.