OK: prescribers can prescribe as much MME for chronic pain as they want…as long as they don’t show up on monthly top 20 prescribers

New opioid law aims to cut down on abuse, but some say it hurts those who need pain medication


A state law that takes effect Thursday mandates new prescribing limits for opioids, but some worry it could end up hurting patients who suffer from chronic pain.

Senate Bill 1446 will limit initial opioid prescription terms and require providers to take extra measures when dosages exceed certain thresholds.

The new law has been hailed for its attempt to address opioid abuse in the state.

Oklahoma ranks No. 6 in the nation in opioid prescriptions dispensed per capita, according to the U.S. Centers for Disease Control and Prevention.

“This certainly does have the potential to curb a lot of abuse and even prevent some addiction, let alone help with some of those who might already be addicted, to slowly get them off of some of these medications much sooner than they would without it,” said Mark Woodward, spokesman for the Oklahoma Bureau of Narcotics and Dangerous Drugs Control.

However, state officials have been scrambling in recent weeks to answer questions from doctors, pharmacists and patients about the new law.

“There’s already a lot of confusion about this law,” said Dr. Blake Kelly, a pain management specialist.

One aspect of the new law limits initial opioid prescriptions to treat acute pain to a seven-day supply for patients.

After the initial prescription, a practitioner may issue another seven-day supply of opioid drugs if necessary, following a consultation with the patient.

Patients must enter into a pain management plan with their provider if the second, seven-day supply is exhausted and additional opioids are to be prescribed.

Woodward agreed that the new law has led to some confusion among patients and providers.

“We’ve had some patients who have called and said they have been fired by their physician, because the physician can no longer prescribe the amounts they have previously been prescribing,” Woodward said.

Woodward said face-to-face consultations between the provider and the patient are recommended, but not required, under the new law.

Kelly said he has heard some pharmacists are not filling patient’s prescriptions “because they are saying you can only get a seven-day supply.”

The initial seven-day limit only applies to new patients, Kelly said.

The law also does not apply to patients receiving active treatment of cancer, hospice, palliative care or residents of a long-term care facility.

Woodward said the seven-day limit on an initial opioid prescription could help curb abuses of the powerful, addicting drugs.

“I think it certainly does have the potential, with the seven-day limit, in preventing some people from getting on the path that would lead to addiction,” Woodward said. “Because clearly the longer you are on any kind of prescription opioid the greater the risk.”

Tamera Stewart, a chronic pain sufferer, said the new law began affecting her prior to it becoming law, following a visit to her pain management doctor’s office.

“In April of this year, the PA (physician assistant) walked in and said ‘not because of anything you have done, but I have to reduce your pain medicine in part because of a new law coming out in Oklahoma,’” Stewart said.

Stewart is national administrator of the Facebook group Coalition of 50 States Pain Advocacy Group.

A two-time cancer survivor, Stewart has undergone 13 surgeries.

The 37-year-old said she first tried steroids and other alternative therapies before turning to opioids about 10 years ago to manager her pain.

Stewart, who is also active in the Don’t Punish Pain Oklahoma advocacy group, said she has heard concerns from others who are worried they will lose their pain medications as a result of the law.

“I got involved (in advocacy) when I started hearing about older residents in my community being told they were not going to get their pain medicine,” Stewart said. “Because I am also a pain patient, it scared me.

“People are being literally abandoned by my doctor,” Stewart said.

Woodward confirmed that patients are reporting that their providers have dropped them or cut back their opioid dosages due to language in the law dealing with opioid dosage levels.

The new law requires providers to document and consult with patients when they are prescribed daily opioid dosages that are equivalent to or greater than 100 milligrams of morphine, abbreviated to 100 MME.

Many doctors already consulted with patients and documented when they exceeded the 100 MME dosage levels, Woodward said.

Still the threshold has prompted concerns.

“There’s some misunderstanding by some who think that the law says that you cannot prescribe pain medicine that would be more than 100 morphine equivalent or MME,” Woodward said.

The law clearly says doctors can continue to write as high a dosage as they believe is needed, Woodward said.

Those who do will have to maintain a written policy and engage in informed consent with the patient if they want to prescribe opioids that exceed the 100 MME, Woodward said.

“But there is no restriction that says anywhere that patients have to be at or under 100 morphine equivalent doses,” Woodward said.

Stewart said providers are fearful if they don’t reduce opioid dosages that they prescribe, they could end up on a state list that identifies them as a top prescriber.

“It’s an environment where everybody is afraid to write prescriptions because of the stigma,” Stewart said.

At issue is a list of top 20 prescribers of opioids that is generated monthly by the OBNDD.

The agency has been providing the list for years to state medical regulatory boards, Woodward said.

“That’s some of the concerns we are trying to get physicians to understand, if they are over 100 MME and they are on a list because they are one of the top prescribers, that doesn’t mean they are under investigation,” Woodward said. “It is simply a list that is generated by law.”

Kelly said everyone agrees that opioid dosages need to come down.

“But the concern is if someone is at three, four or five hundred MMEs and we wean them down to the 150 or 200 range and they are suffering, do we continue to wean them down, or is it understandable to leave them there understanding that they are on half the dosage that they were on for 10 years and they are barely able to get off the couch or out of bed at this level,” Kelly said.

“If we take them down lower what kind of quality of life are they going to have?” Kelly asked.

2 Responses

  1. Is this the one of the states that tried to legislate the value of pi? They clearly don’t begin to understand things like…basic math & percentages. Even if every doc in the state never prescribes more than 10 total pain pills a year, there’s gonna be a top 20%. If you keep getting rid of the top 20%, eventually you have zero. The only way you won’t have a top 20% is if everyone prescribes none (or everyone prescribes the exact same non-zero # of pills). None is probably the goal anyway, tho they should come right out & say so instead of sounding like utter & complete morons.

  2. “Kelly said everyone agrees that opioid dosages need to come down.”

    I really, really hate these sorts of statements; they get me practically foaming at the mouth b/c they’re blatantly, outrageously false & based upon utter lies. They merely parrot the PROPaganda promulgated by the Kolodny & Kompany Klowns.

    I had my 3-month follow-up with my new doc the other day (old one of 15 years retired early this year). Altho he’s (so far) been willing to continue to prescribe my pain meds (same dose for many years, with a one-year gap 4 years ago when my former doc got off medicare for a year), he started honking on about how of course “we” want to start tapering down to see how I do on lower doses or none at all. I pointed out that I knew perfectly well how I do without –the year off nearly drove me to suicide from pain & zero functionality. ‘But we at least need to get you below the 90 MEDD.’ I pointed out that I’m already 30% BELOW the 90 MEDD, so that’s already well taken care of. Back to “we” want to taper, but only if “I” [the patient] wanted to, which of course he was sure I did..tho I’d already made it very clear I didn’t. It was frigging surreal.

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