Nearly 80% of the world’s prescription painkillers are consumed in the United States, a number that increased substantially from 2000 to 2010 according to the American Society of Interventional Pain Physicians’ 2011 testimony to Congress. States have had to take a long, hard look at their policies for regulating prescription of opioids, re-writing their regulations to help prevent over-prescription and abuse.

Some of the changes include:

  • Re-classifying certain opioids to indicate the increased risk of addiction
  • Starting state-wide databases to log in prescriptions for patients
  • Limiting the conditions for which opioids can be prescribed (and to whom)

In September of 2013, the Food and Drug Administration (FDA) proposed reclassifying the drug hydrocodone from a Schedule III drug to a Schedule II drug. This change means that a patient would have to obtain a written prescription (as opposed to getting one called in), and the prescription would have no refills. Patients would have to visit the doctor again to obtain a refill. Indications for opioid prescriptions would also change from use for moderate to severe pain to use for severe, intractable pain. This change may prompt doctors to seek other, non-opioid treatment for episodic, moderate pain. Physicians in Arkansas are not allowed to prescribe Schedule II, III, IV, or V narcotics for longer than six months unless they comply with a long list of checks and balances to ensure that the patient truly needs opioid pain management.

Most states in the union have implemented statewide databases for patient prescriptions of all kinds, with a special focus on opioids.

As of October 2011, the Prescription Monitoring Program (PDMP) is fully operational in thirty-seven states and approved but not operational in another eleven (see the Drug Enforcement Administration’s website for more stats and a description of the program). These programs prevent “doctor shopping,” and help doctors keep track of their patients’ prescription filling habits. Patients who seem at risk of abuse due to frequent refills or refills in different pharmacies will have that noted on their records and will be advised.

Finally, states have recognized that opioid regulations must address the issue of over-prescription for the treatment of conditions other than pain. For example, Indiana expressly forbids prescription of opioids for weight loss, and in most states, doctors are not allowed to prescribe opioids for themselves or their immediate families. States like Georgia require a “Ten Step” approach to prescribing for pain control that includes a close examination of a patient’s history, regular monitoring of a patient during treatment, and documentation that other treatments were ineffective.

For a full list of what each state is doing for opioid regulations, visit Medscape’s website. Do you think your state is doing enough?

Image by ttarasiuk via Flickr


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