New law limits pain prescriptions

Opioid prescriptions for acute pain are now limited to three- or seven-day supplies in Florida.

Pain is one of the top reasons people visit their health care providers, but how these providers treat pain in Florida has changed. On July 1, new restrictions were placed on prescription painkillers in an effort to save the 16 Floridians who die every day from opioid drug overdoses, according to state officials.

“If your practice prescribes controlled substances, especially opioids, on an outpatient basis, this law affects you,” said Alberto Ardon, MD, chair of the Pain and Opioid Stewardship Taskforce at UF Health Jacksonville.

Opioid prescriptions for acute pain can only be prescribed for three days or, when deemed medically necessary, for seven days.

“The prescriber must adequately document in the patient’s medical record the acute medical condition and lack of alternative treatment options that justify deviating from the three-day supply,” Ardon said.

These medication restrictions do not apply to traumatic injuries with an injury severity score of 9 or above, cancer, chronic pain, terminal conditions or palliative care.

Physicians are now required to take a two-hour, Florida board-approved continuing medical education course on prescribing controlled substances. In addition, they or their staff members are required to check the statewide prescription drug monitoring program before prescribing or dispensing any controlled drugs on an outpatient basis.

“Previously, only physicians who prescribed a lot of pain management prescriptions were usually registered,” Ardon said. “Now all Florida physicians who prescribe any controlled substances are required to register and actively access the database.”

The new law also affects pharmacists. Any dispensed controlled substance must be reported in the database no later than the close of the next business day, unless an extension or exemption is approved. Failure to do so can result in a series of citations that can escalate to a first-degree misdemeanor.

“The new law has changed the workflow within clinics, but these changes are not insurmountable if the providers and staff have anticipated and prepared well for the changes,” Ardon said.

UF Health Jacksonville and UF Health North were already making changes to their pain management policies based on national recommended guidelines, but this law has sped up efforts.

“Our surgery patients, who may be accustomed to getting a specific number of pills, are now receiving significantly lower amounts,” Ardon said. “We continue to work to minimize postoperative pain in other ways, such as using nerve blocks and prescribing non-narcotic medications like acetaminophen and anti-inflammatories. Patients also play a major role in pain management. Eating healthier diets, exercising and using relaxation techniques can really impact a person’s perception of pain.”

The new law allocates an additional $53 million in state funding to enhance opioid treatment, law enforcement response and provide the lifesaving overdose-reversal drug Naloxone to first responders.

“The national opioid epidemic is a multifaceted, multicontextual problem with no clear single solution,” Ardon said. “It is going to take changes in law enforcement, medical care, accessibility to mental health and rehabilitation services, and patient mindsets to see success and save lives.”