Rick Scott’s opioid bill is getting pushback. Should it?

Other states already have prescribing limits and share drug data, but Florida Republicans, doctors and drug companies are fighting it.
File photo of Gov. Rick Scott.
File photo of Gov. Rick Scott.
Published Jan. 5, 2018|Updated Jan. 30, 2018

Gov. Rick Scott is pushing legislation that would be a modest step toward combating the state's growing opioid crisis.

But it's placing the former health care company CEO in an unusual spot: at odds with doctors, drug companies and some fellow Republicans, who fear losing control or profits from Scott's legislation.

At issue are four proposals: to stop doctors from prescribing more than three days' worth of opioids to treat acute pain, to share a state database of opioid prescriptions with other states, to require doctors to check the database before prescribing opioids, and for them to be trained on proper prescribing techniques.

Together, they are considered "best practices" to prevent patients from becoming addicts. Other states have already adopted the proposals, which have helped stop addicts from getting more drugs.

Yet the bill already has nearly 200 people registered to lobby it in the House — and most are likely to have problems with it.

Purdue Pharma, the makers of Oxycontin, the painkiller most responsible for starting the opioid crisis 20 years ago, is among the pills targeted by Scott's bill. The company says it "fully supports" the legislation, however.

Records show that House Speaker Richard Corcoran's brother, Michael Corcoran, is lobbying on behalf of Purdue. The speaker himself also supports the bill.

Jeff Scott, general counsel for the Florida Medical Association, said he's taking a wait-and-see approach.

"I'm not pushing anything at this point. I want to hear the testimony at the first committee," Scott said.

But he urged legislators to "be rational" about the limits on opioid prescribing.

"If you look at the other states that have imposed the limits, nobody has an actual limit of three days," he said.

That's not true —Kentucky does. And doctors there say the three-day limit has made patients safer.

Other Republicans have voiced concerns that expanding the drug database to other states could lead to abuses.

But those concerns are questionable and have been eclipsed by an epidemic that killed nearly 15 people a day in Florida in 2016 and even more per day in 2017.

"Florida is known as a destination for those looking for opioids, and unfortunately, our database creates an artificial border that doesn't exist in reality," said Palm Beach County State Attorney Dave Aronberg.

The legislation that Scott supports, HB 21 and SB 8, would require doctors to treat acute — or short-term — pain with no more than a three-day prescription.

It applies only to schedule II narcotics, such as OxyContin and fentanyl, and doctors can override that to a seven-day supply if they document why it's medically necessary.

The purpose behind limits is to prevent patients from becoming dependent on the drugs or addicted to them.

According to data from the Centers for Disease Control and Prevention, people being treated for acute pain have a 6 percent chance to still be on the drug a year later if given a one-day prescription. With a 12-day supply, the chance of still using the drug a year later is 24 percent.

While there could be many factors that contribute to how a person responds to opioids, the study's authors felt that when looking at other studies of long-term opioid use, there was a high likelihood that many of the patients became dependent on the drug.

Dependence means that the patients were taking the pills as prescribed, or to avoid withdrawals, and it could easily lead to addiction – or abuse – of the drugs.

While other states have adopted five- or seven-day limits, only Kentucky has gone to three days.

Pat Padgett, executive vice president of the Kentucky Medical Association, said there are enough exceptions to the three-day limit, including cancer patients and those in hospice care, that patients who need the drugs have been able to get them.

He said emergency room doctors were initially concerned about patients being able to come back to the hospital to renew their three-day supply.
"We have not heard any specific instances where that has been a problem," he said.

Just how many Floridians would be affected by the policy is unclear. But state and federal data suggests that hundreds of thousands of Floridians could become dependent on opioids of all types every year.

In 2016, Florida doctors wrote opioid prescriptions of any kind to 3.6 million people with acute pain who were not previously taking opioids, according to data from the Department of Health.

Of those, 1.4 million — nearly 40 percent — were given at least a seven-day supply of opioids. How many were given the schedule II drugs are unclear.
That alone goes against recommendations by the Centers for Disease Control and Prevention, which says opioids of any kind should be limited to three-day prescriptions for acute pain.

When compared to the CDC data, of those 1.4 million patients in 2016, it's likely that at least 200,000 of them became dependent on the drugs and were still using them in 2017.

The requirements on the state's Prescription Drug Monitoring Program are even less controversial. Kentucky has required doctors check it since 2012, using it to catch "doctor-shoppers."

And at least 40 states share the data across state lines, with no problems.

Incoming House Speaker José Oliva, however, told Politico Florida last month that he and other conservatives feel the data could be "weaponized" by governments.

"The governor is a good man with good intentions trying to solve a large crisis," Oliva said. "But it is possible that information from the PDMP could be used and misused in many different ways."

Editor's note: A recent study by the Centers for Disease Control and Prevention showed that long-term opioid prescriptions led to opioid dependency, but not necessarily addiction. Also, Purdue Pharma says it is "very supportive" of Gov. Rick Scott's opioid bill, which includes a three-day limit on prescriptions. An earlier version misstated these points.