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Limiting Pain Pills Prescriptions To 7 Days? Florida Surgeons Say No.

| January 11, 2018

No refills. (Adam Cohn)

No refills. (Adam Cohn)

Seven days’ worth of pain medicines are inadequate for patients who’ve had their chests ripped open for heart surgery or had their hips or knees replaced, doctors told lawmakers considering legislation aimed at curbing the state’s opioid crisis on Wednesday.


As opioid-related deaths in Florida continue to skyrocket, Gov. Rick Scott and lawmakers have deemed what many — including doctors, law enforcement officials and child welfare workers — label a public-health crisis a top priority during the 60-day legislative session that began Tuesday.

Scott wants to spend $53 million, more than half of which comes from federal funds, to address the issue.

The governor is also pushing a proposal that would restrict doctors to prescribing between three and seven days’ worth of opioids for patients with acute pain and would force physicians to consult a statewide database before prescribing potentially addictive pain medications.

The House Health Quality Subcommittee late Wednesday unanimously approved a measure incorporating the prescription drug limits, after surgeons objected that the changes could pose problems for patients who’ve undergone open-heart surgery or had their hips or knees replaced.

“A neurosurgeon who does a craniotomy is going to create a pain that is going to last more than seven days. A cardiovascular surgeon who does a coronary bypass and has to break the ribs to get into the cavity is going to create pain for more than seven days,” said Chris Nuland, a lobbyist who represents the Florida Neurosurgical Society and the Florida Society of Thoracic and Cardiovascular Surgeons.

Nuland said that, if surgeons aren’t allowed to give longer prescriptions, patients will have to remain hospitalized longer.

“And that’s not good for the patient. It’s not good for the system. That all being said, the days of sending someone home with 90 days of opioids are over. We recognize that,” he said.

Earlier in the day, Brian Luskin, a Palm Beach County orthopedic hand surgeon, told the Senate Health Policy Committee that, while he supports the state’s attempt to rein in prescription drug abuse, the effort “raises some issues that affect the reality of orthopedic care.”

Many patients who have undergone orthopedic surgery need to take opioids for two to three weeks afterward to manage their pain, Luskin said.

Under the Senate and House proposals (SB 8 and HB 21), patients would have to get additional prescriptions for pain medications from their doctors because refills for the Schedule 2 drugs cannot be called into pharmacies.

That’s problematic in a state where between 200,000 and 300,000 hip and knee replacement surgeries are performed annually, according to Luskin.

“It is almost infeasible for some of these people to get back to the clinic within the seven-day time frame,” he said.

Rep. Jim Boyd, the sponsor of the House measure, said there might be some way to accommodate the surgeons, but he seemed skeptical.

“I listened to the testimony about cracking somebody’s chest open. I’m not making light of that. But I have a friend who had his chest cracked open. They gave him 90 days of opioids. He took two Tylenol and he never had a bit of pain,” Boyd, R-Bradenton, told reporters after the meeting. “I’m not saying that works for everybody. I think there’s some conversation we can have, but I want to make sure we don’t water down our initiative just to accommodate perhaps a one-off situation.”

The Senate Health Policy Committee heard testimony from doctors and others regarding Sen. Lizbeth Benacquisto’s bill (SB 8) earlier in the day, but Benacquisto asked the panel to hold off on a vote until next week so that some changes could be made.

Benacquisto said she is exploring the issues raised by the surgeons, but she, too, seemed wary about backing down from the seven-day maximum.

“I am focused on what is best for everyone. It is a balancing act because the statistics, the numbers don’t lie. The longer someone is on that medication, the increase in ability for them to become addicted. It is those folks who are receiving the medications as a result of these types of injuries that by and large are becoming addicted, and I am going to be very careful about how we move forward with any adjustment to dosage timelines,” the Fort Myers Republican told reporters Wednesday.

The measures would restrict doctors to prescribing three days’ worth of opioids to patients with acute pain but would allow them to prescribe up to seven days’ worth of the pain medications if they deem it “medically necessary.”

The time limitations are based on a U.S. Centers for Disease Control and Prevention guideline, which advises that “three days or less is often sufficient and that more than seven days will rarely be needed” for acute pain, according to a House staff analysis of the bill. The limits are grounded in research that show patients who took powerful pain medications for the first time had a higher chance of developing dependencies with longer prescriptions.

Whether the legislation will be tweaked “will play itself out in this process,” House Speaker Richard Corcoran told The News Service of Florida on Wednesday.

“The goal is to end the scourge that opioids have presented to our state. We’ve been fighting this fight since I first got elected …and now here we are seven years later, the scourge still exists,” Corcoran, R-Land O’ Lakes, said.

Corcoran said that other states have had success in combating opioid addiction when restrictions on prescription lengths have been imposed.

“I think, through the committee process, we will be able to improve and make the bill work for those who actually need the pain medication and clamp down on an over-excessive amount of pills being prescribed to people who don’t need it,” he said.

–Dara Kam, News Service of Florida

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12 Responses for “Limiting Pain Pills Prescriptions To 7 Days? Florida Surgeons Say No.”

  1. Dave says:

    Beautiful Beautiful, I love it! Its true , pain isnt that bad , people now adays dont want to feel anything but thats part of being human, take some tylenol, some medical marijuana, and you will be fine. Ive never filled my prescription for pain pills after surgery, its not necessary.

  2. Bc. says:

    What a joke a junkie will get their drugs off the black market they will find heroine and fentayl much cheeper than RX. Drugs ALL YOU WILL DO IS HURT THE PEOPLE WHO NEED THEM. A junkie is a junkie when the pill mill crack down happened which was a good thing all it did was make the cartels richer the drug addict went from pills to black market drugs if you think having a knee replacement patient being in pain is going to drive to the drugstore it won’t happen. You need to do more research. Remember the war on drugs yes that worked just great. You need to put your efforts to rehabilitate the junkie not hurt the people who need them to recover from surgery or the people who are in chronic pain that need them every day.

  3. South Florida says:

    i had right shoulder surgery on December 27th 2017. i was inpatient ormond hospital one night and Dr. james Bryan did 5 procedures to this shoulder and it feels so bad as if i g
    had a bullet in me. he would only allow 1 to 2 5mg Percocet at hospital and denied my maintenance medications including amxiety and breathing. this is exactly 2 weeks since surgery and i cant get this asshole to REFILL anything. dont bother having a 2cm full rotator cuff tear repaired because you will be left in my position of being in unecessarry pain and he treats me like im a junkie. i have never had a drug problem and its pussing me off.

  4. retired says:

    its great that some readers are so strong and tough not to ever fill his pain pill meds, but try getting shot, having a leg blown off after driving your truck over an IED in Afghanistan, then come back and say ‘no, doc, I can handle the pain, I’m a tough guy.
    I’d give anything to live in your comfy sheltered world. Wait, I cant, I was too busy protecting yours.

  5. Richard says:

    Here we go! Persecute everyone just because there are stupid ignorant irresponsible people who abuse these pain medications. Hold everyone hostage because of a few bad apples. I vote for throwing the bad apples in a forced lock-downed rehabilitation facility to get them off of the pain meds and let the people who really need them go on with their daily lives.

    All this will do is cause me to have the doctor write multiple RX’s which I will turn in as needed. I do that anyway when I leave Florida for 3-4 months and need medication while on my travels.

  6. Collapsing Spine says:

    My spine is slowly collapsing from a crushed vertebrae. I’ve lost 4 inches of height so far. The injury itself is stable, but if I go into surgery, I have a 50/50 chance of being paralyzed. My anesthesiologist has advised me that I won’t qualify for pain relief that my doctor feels is necessary soon.
    Legislators see sensational stories and want a quick fix that will destroy my ability to get out of bed and put me on a wheelchair. But do let’s focus on the drug addict in the street buying illegal drugs.

  7. smarterthanmost says:

    For people wanting single-payer healthcare, this is just one example of what you can expect.

  8. John says:

    I agree with the 7 day limit. Stop the pill mill. Unscrupulous Doctors push certain medications for no other reason than they’re receive goodies from pharmaceutical reps. Stop Lobbyists access to State and Federal buildings. They are a big part of the problem.

  9. Anonymous says:

    I have broke my back twice, have lost 5 inches in height, have scoliosis, spondilotheses, degenerative disc, osteoporosis, pinched nerves, etc etc. the neurosurgeon says surgery would make me worse and my only opti on is controlling the pain. I go to pain clinic. In 4 years have never asked for increase in meds, but I’m made to feel like a junky. If they take opiotes away, I won’t be able to get out of bed. All this scares me to death. I wear a back brace now or I can’t go anywhere.

  10. Anonymous says:

    This is not a solution. This is only going to make the people who need the medication to suffer! How lame can our law makers be. Now that law makers have known pill mills have been passing pills out like candy and the prescription pill problem is out of control law makers want to make it appear they are doing something to show they care….this is a little too late and not what needs to be done. This is going to fix nothing!!

  11. Dave says:

    From these comments it is clear a number of our residents are already hooked on pain pills and dont even realize it, IF YOU ARE EATING PAIN PILLS YEARS AFTER YOUR INJURY, you are addicted to these pills, unfortunately todays society thinks it is ok to live comfortable no matter what, imagine all the people who want medical marijuana instead of pills but are being denied, and marijuana is natural and far better for you

  12. Get Real says:

    There are many factors that go into how a person, legitimately builds up a tolerance to the prescribed pain pills and in order to get a little comfort and relief the Dr have to raise the prescription, either by the mg or amount. People who do not live in pain 24/7, really have no idea.

    These pills do not take all the pain away for a person who lives in pain, the pain pills only lowers it and most of the time its not by a lot but when you are in pain all the time, any help at all can be a Godsend.

    The pain I’m talking about isn’t slight, it isn’t a pain that heals or gets better over time. I like many others, have 5 discs that are bulged and herniated, pinching nerves. I have osteoarthritis in both hips, narrowing of the spinal canal on the spinal cord, chronic neck and shoulder pain associated with whiplash. These issues cause me to be in severe pain most of the time, if I’m lucky some days it is moderate, and this is taking my pain meds.

    Most people feel that initial burst of pain with an injury and then their endorphins kicks in and the pain is lessened naturally but in time the body stops churning out the endorphins and they start to feel all that pain at its full glory again, if their lucky they are being treated by then and have an iv and have been given pain medication to ease the pain until their bodies have begun to heal and the pain begins to subside. As the pain lessens, as they heal more and more, they don’t need the pain medications as much and can quit taking them.

    Now imagine that instead of healing or the pain lessening, that initial burst of pain, that was another persons worst pain to go through, was the best you are ever going to feel. Instead of getting better, that pain only grows and becomes worse over time. Your entire life before that point, every injury would heal but this time it will never heal, never go away. Instead by trying to live life, moving, twisting, turning, walking, no matter how careful you are, it will only get worse.

    I don’t take pain meds to escape my reality, there is no escaping the reality of being in pain. The Dr’s I’ve been to were always cautious of treating the pain but slowly raising the prescriptions only to match the tolerance my body was accumulating to the meds. I never wanted the euphoria, I only had that once slightly by my pain meds in the years since I became disabled. I just never wanted that, never wanted to live in a haze or a dream state.

    For people like myself and there are many others, this is just going to make my life that much more uncomfortable. My Dr is quite a ways away from my home, due to my insurance and the ritual of getting ready, the drive, the wait in the waiting room, I actually enjoy seeing my Dr but I don’t know, that may change a lil if I have to do it every 3 days or even every 7. I won’t have a choice but to have to do it but it will be that much more of a toll on me. By having to go through the process of seeing my Dr to get scripts every 3-7 days, now I’m losing the some of the limited things I get to go out and do for myself.

    I only have so much I can physically do in a week, is it going to be wasted on getting my scripts now?

    Figure I start preparing to see my Dr at least an hour before I leave for my appointment, I get in my truck and drive through crappy traffic for at least 40 minutes to get to the Dr’s office, Sit for at least 30min most of the time before they call my back to a room. The Dr usually see’s my fairly quickly, once I am in the room, 15min. Then we go through the steps of the visit, another 20min. Then the ride home through crappy traffic, another 40 min.

    60
    40
    30
    15
    20
    40

    3 hours and 42 min to go to an appointment, then on top of that throw in another hour to drive to the pharmacy, wait for the prescriptions to be filled, and to drive home.

    That’s close to 5 hours and doing that once a month wasn’t fun. Now I will be having to do that 4 – 10 times a month… I’m usually able to get out of the house 3 times a week for about 5 hours each time, if I’m lucky. 12 times a month and that put me through a lot of pain and stress but at least I got to get out and try to enjoy some quality time with family and friends. Sad times ahead, indeed…

    I thank God that most people aren’t aware of the way some of us with chronic pain live, not a clue…

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