Simple Rule Change Could Expand Efficacy of Opioid Prescribing Guidelines

In the wake of the destruction caused by the opioid epidemic, public health researchers are doing everything they can to find ways to reduce drug overdoses and addiction-related harm. One group of researchers at the Child Health Evaluation and Research Center at the University of Michigan discovered that something as simple as setting time limits on prescriptions might reduce addiction risk for as many as 260,000 Americans.

Research Findings Suggest a Need for Time Limits on Opioid Prescribing

A new study found that about 1% of opioid prescriptions for acute pain symptoms (the equivalent of a quarter-million prescriptions each year) are filled more than one month after they were written. That almost certainly means the prescriptions are being filled for another reason, not what the doctor initially intended the prescription to treat.¹

One can easily understand why it would be harmful to a patient who receives an opioid prescription for a specific short-term (acute) malady to then fill that prescription for some other reason several weeks later. The study’s authors have a very simple recommendation: Doctors should add time limits to their prescriptions. Doing so would eliminate the late-filling of prescriptions and potentially help curb opioid misuse.

Adding time limits would ensure that patients could still receive opioid painkillers for the acute pain they were struggling with while also ensuring those prescriptions would not be used for other reasons later on. Dr. Kao-Ping Chua, a pediatrician and member of the University of Michigan’s research team, spoke about this issue. Dr. Chua highlighted the importance of opioid pain relievers only being used to treat exactly the condition the doctor is prescribing them to treat. “Our findings suggest that some patients use opioids from surgeons and dentists for a reason or during a time frame other than intended by the prescriber. These are both forms of prescription opioid misuse, which in turn is a strong risk factor for opioid overdose. It’s perplexing that states would allow controlled substance prescriptions to be filled long after they are written.” There is a clear need for better ground rules on creating expiration dates for opioid prescriptions.²

It’s a Policy Issue Too

After determining that 1% of opioid prescriptions were being filled well after their intended date of use, the researchers determined what types of laws exist to regulate prescription-filling. As of 2019, 18 states still permitted prescriptions for Schedule II opioids and other controlled, mind-altering substances to be filled up to six months after the doctor wrote the prescription. Another eight states allowed for such drugs to be dispensed by a pharmacy for up to one year.

In no world does it make sense for an opioid prescription intended to treat acute pain to still be valid after several months, much less one year. Dr. Chua and fellow researchers strongly recommended states tighten their laws on prescribing, to ensure patient safety.

The researchers included an example of when one state did just that. Minnesota introduced a law in 2019 that prohibited pharmacies from dispensing opioids more than 30 days after a doctor wrote the prescription. Shortly after that law was introduced, delayed dispensing of opioid drugs quickly dropped across the state.

The CDC’s Original Prescribing Guidelines

At the time of this writing, the Centers for Disease Control and Prevention are currently updating their opioid prescribing guidelines (the original draft was released in 2016). Those guidelines sought to reduce the overprescribing of opioid pain relievers. The trend of doctor overprescribing had caused harm and contributed to the spread of the opioid addiction crisis during the 2000s and 2010s, hence the need for the CDC to step in and set ground rules for safe and effective prescribing.

The CDC guidelines were quite strict and did not pull any punches to make clear the importance of conservative opioid prescribing. Quoting two passages from those guidelines:³

“Opioids are not first-line therapy. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.”

“Opioids are not first-line therapy. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

and,

“Use the lowest effective dose… [and] prescribe short durations for acute pain. Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.”

This language and other passages from the 2016 CDC guidelines are quite direct in pushing for hesitation, caution, and conservatism in opioid prescribing. But the original draft of the guidelines did not mention prescription time limits.

Changing Laws Can Save Lives

It would be wise for the CDC to include in their updated prescribing guidelines a recommendation for doctors to limit their opioid prescriptions to only being valid for 30 days or less. Further, individuals, patients, families, and communities should advocate for state laws that place time limits on potentially addictive, risk-inherent drugs like opioid painkillers. Doing so would be a simple and effective tool for curbing the misuse and self-medicating usage of such drugs. It would help prevent addiction and overdose, thus saving lives.

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