In October the U.S. Food and Drug Administration proposed tightening restrictions on access to certain low-potency narcotic pain medicines in an effort to stem the rising tide of prescription-drug abuse in the United States. The new rules would require patients to visit their doctors more often to refill their prescriptions and prohibit pharmacists from filling prescriptions over the phone.
The recommended changes may seem innocuous to many Americans, who are accustomed to getting just one side of the story on prescription-drug use. In fact, they are part of a disturbing trend that threatens to disrupt access to life-sustaining medication for millions of law-abiding citizens while having minimal impact on levels of drug abuse and addiction.
The move by the FDA to reclassify low-level hydrocodone preparations like Vicodin as Schedule II narcotics — the same category currently assigned to stronger pain medications, including fentanyl and morphine — follows several years of unilateral action by the states to erect new roadblocks to pain management. Advanced under the guise of protecting the health of Americans, these restrictions represent a heedless expansion of the war on drugs at the expense of the privacy and well-being of innocent patients.
In Pennsylvania, Republicans in the State Assembly are pushing legislation that would inappropriately expand access to the commonwealth's prescription-drug-monitoring database and automatically notify the state attorney general and local prosecutors of "irregular" dispensing patterns. If this effort were about proper government monitoring, then the very same coalition would not simultaneously be working to dismantle the state's firearms-transfer database. The American Civil Liberties Union and the Pennsylvania Medical Society have filed briefs in opposition to the bill.
In Indiana, the legislature passed a bill last spring requiring the state's Medical Licensing Board to adopt a set of emergency protocols governing the prescription of opioid pain medication that include mandatory drug screening of people prescribed opioids to ensure they are taking the drugs as prescribed. The new standards went into effect in October.
Two years ago Washington state adopted new restrictions on dispensing opioid painkillers that are among the strictest in the nation. The law holds doctors accountable for tracking patient behavior and administering random urine tests, and it set a first-of-its-kind dosage threshold of 120 milligrams of morphine or its equivalent per day before a prescribing doctor must get a special evaluation from a pain specialist. Only cancer patients and those in hospice care are exempted.
Blowback from the law was swift and widespread. Within months of its taking effect, hundreds if not thousands of patients had been denied life-enabling medications "by doctors leery of the burdens and expense imposed by lawmakers," The Seattle Times reported.
A number of other states — including New Jersey, Oklahoma, Tennessee and Ohio, which recently introduced its own dosage thresholds — are considering or have passed similar measures as part of their efforts to address the growing epidemic of painkiller addiction.
"We are trying to prepare our state for what we hope is the inevitable curbing of the use of opiates in chronic pain," Orman Hall, director of Ohio's Department of Alcohol and Drug Addiction Services, told The New York Times last year.