The opioid crisis claims more than 100 lives a day. It’s ripping apart families from affluent suburbs to Rust Belt cities and swelling emergency rooms and county jails. But as lawmakers scramble to enhance regulations on prescription, there’s fear that a political panic might impose a cure that’s worse than the disease.
Trump entered office promising to rein in the opioid crisis by reforming health-care policies and cracking down on drug sales. Congress is meanwhile pushing aggressive law-enforcement and regulatory measures. A newly passed House bill, combining about 60 different proposals, would impose prescription limits, expand research and treatment programs, and promote alternatives to opioid medications to help stem addiction. Already, some advocates have criticized the legislation as too soft on pharmaceutical corporations, which lobby fiercely against regulations on distribution and marketing of drugs.
Yet resistance is emerging in the medical community as well, amid an ethical debate over how to restrict clinicians from over-prescription without constraining doctors too harshly at the expense of critical care.
The latest proposal to limit opioid prescription coming from Washington targets dosage standards for coverage under Medicare-related insurance. Last March, the Centers for Medicare and Medicaid Services (CMS), which administers federal Part D prescription drug plans, floated a tightened limit on dosage in Medicare insurance-payment standards, in an effort to tackle opioid overuse in a major at-risk group, aging Medicare patients. But the proposal was later walked back following public criticism, when some doctors warned that tighter restrictions could actually result in aggravated pain, addiction, or both.
One group of medical professionals published an open letter about the CMS guidelines, arguing for a more balanced approach to both safely treat chronic pain and safeguard against drug addiction. They argue that the payment rules proposed by CMS, which would limit dosage to 90 milligrams of morphine per day, could impact about 1.6 million patients. (Previously, the CMS proposed a general 200 milligram ceiling.) Under the CMS system, prescribing a dosage beyond the threshold would be blocked, pending a waiver from the insurer, which generally requires doctors to explain a patient’s exceptional circumstances, such as a particularly intense disease like terminal cancer, or hospice care.