Doctors, Ohio senator argue about pain pill restrictions

SANDUSKY — U.S. Sen. Rob Portman, R-Ohio, is in a public argument with the American Medical Association over his proposal to limit initial pain pill prescriptions to just three days.The AMA said Portman is interfering with decisions that should be made by a doctor, not the government. Portman replied that doctors are to blame for much of the ongoing opioid epidemic.Porman's SB 2456, a bill to reauthorize the Comprehensive Addiction and Recovery Act of 2016, includes a limit of a three-day supply for an initial prescription of opioid pain pills. Doctors could then supply an additional prescription, if necessary.The limit would not apply to chronic pain patients, cancer patients, hospice patients and patients receiving palliative care. U.S. Sen. Sherrod Brown, D-Ohio, was listed last week as one of the 10 co-sponsors of the bill.Dr. Patrice Harris, M.D., chair of the AMA Opioid Task Force, said Portman's bill is an apparent misapplication of guidelines issued by the Centers for Disease Control."The CDC guidelines are voluntary and do not include a hard limit. They were intentionally drafted with flexibility, and they were not intended to be codified. Congressional efforts to codify a strict limit on prescribing opioids are inconsistent with both the language and spirit of the guidelines," Harris said after the Register asked about the AMA's position."They are intended to inform the decision-making process of primary care physicians in the outpatient setting who are prescribing opioids for chronic pain. It is not intended to replace the clinical decision making between physician and patient that takes into account the unique circumstances of a particular clinical situation," Harris said.Harris said 39 states have taken action to reduce pain pill prescriptions, usually in partnership with medical providers.Portman, asked about the AMA's criticism during a telephone conference call with Ohio reporters, fired back that many doctors are to blame for pain pill addiction."Doctors have not used good judgment over the years, as a rule, because they have overprescribed medication consistently. Not every doctor, but too many," Portman said. "I'm tired of going home and hearing the stories of somebody who became addicted initially through having an accident or an injury. It's upsetting. And if you look at it, probably eight out of the 10 people who overdosed in Ohio started with prescription drugs, some legally, some not, but many because a doctor told them it was OK. I think we need to crack down."The CDC's website says its guidelines call for "the lowest effective dose" of opioids when treating for an episode of acute pain. The guidelines appear to stress three days or fewer, but appear to allow for some flexibility and for additional pills after major surgery:"The guideline recommends that if opioids are needed in cases of acute pain (not related to major surgery or trauma, such as acute back pain, sprained ankle), about 3 days will often be sufficient – unless circumstances clearly warrant additional opioid therapy – and that more than 7 days will rarely be needed. If pain continues longer than expected, providers should re-evaluate the patient to make sure nothing was missed."Harris said if Congress wants to address drug addiction, it ought to expand the availability of treatment."A critical missing piece of the congressional strategy is a significant investment to increase access to evidence-based treatment. While recent congressional efforts have authorized several billion dollars to address a wide variety on needs related to the opioid epidemic, those funds do not go very far given the magnitude of the epidemic," she said.Reach reporter Tom Jackson at jackson@sanduskyregister.com and follow him on Twitter @jacksontom.Dr. Patrice HarrisRob Portman