James S. Gessner, M.D.: Partial-fill prescriptions contribute to fight against opioid epidemic

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BOSTON >> Congress has helped Massachusetts and the nation take another step forward in the battle against prescription drug abuse. The Comprehensive Addiction and Recovery Act (CARA), a bipartisan effort incorporating several pieces of legislation targeted at opioid abuse, has been passed overwhelmingly by the House and Senate, and President Obama has signed it into law.

A compelling need to fund some of the law's provisions still remains, but the symbolism and substance of its passage, like the enactment of Gov. Charlie Baker's opioid bill in March, is hard to overstate.

According to the Centers for Disease Control, drug overdose deaths in the U.S. hit record numbers in 2014. While heroin and fentanyl certainly claim their share of lives, prescription opioids continue to fuel the epidemic: at least half of all opioid overdose deaths involve a prescription opioid, and in 2014, more than 14,000 people died from overdoses involving prescription opioids. In Massachusetts alone, more than 1,500 opioid-related deaths occurred in 2015.

CARA includes several important provisions, including greater access to the life-saving therapies of naloxone and buprenorphine, help for infants and veterans, and the reauthorization of the National All Schedules Prescription Electronic Reporting Act, or NASPER, which provides for prescription monitoring programs.

Cut drug-diversion

One provision of CARA, however, can make a big difference: partial-fill prescriptions that will help patients balance the need to relieve pain with an adequate supply of medication by only filling part of a prescription.

The importance of a partial-fill prescription is that it can help to cut drug diversion — something that makes up a significant part of the opioid abuse crisis. Estimates from the National Institute on Drug Abuse indicate that the majority of individuals — up to an astonishing 70 percent – who misuse or abuse pain medications get them from prescriptions written for someone else, such as family or friends.

Advocated by Massachusetts physicians, the partial-fill legislation was championed by Sen. Elizabeth Warren and Congresswoman Kathrine Clark, who co-sponsored the Reducing Unused Medications Act of 2016 that became part of CARA. With few exceptions, U.S. Drug Enforcement Administration regulations had previously prevented partial-fill prescriptions.

While state law also now permits partial-fills, passed as part of the governor's opioid bill, the federal law goes a step further by allowing the patient to fill the unused portion of the prescription, should patients need more relief. State law currently does not. This new provision in CARA will enable Massachusetts to change its law to become aligned with the new federal law.

In prescribing pain medicines, physicians are challenged with balancing the risk of addiction versus ensuring adequate pain relief for their patients. In efforts to reduce patients' pain, however, too many prescriptions have been written, and prescription opioids have played a major role in driving this epidemic.

Partial-fill prescriptions have the potential to shrink the amount of drugs susceptible to abuse and misuse or theft from unsecured locations such as family medicine cabinets — the place where Director of the White House Office of National Drug Policy Michael Botticelli has said the epidemic starts.

The law permitting partial-fill prescriptions is another in a long list of substantive efforts taken to address the opioid epidemic. Here in Massachusetts, we perhaps have had more actions taken much sooner than elsewhere to fight opioid abuse.

Seeing results

Gov. Baker's Opioid Working Group that led to bipartisan landmark legislation, prescribing guidelines and prescriber education offered by our state medical society, and public information campaigns are among endeavors contributing to prevention, education, treatment, recovery. These efforts, underway for more than a year now, are now beginning to see some results in recovery and reduced prescribing rates.

Another major step will be taken in August, when the Department of Public Health launches its new prescription monitoring program, offering enhanced searching capability along with access to data from other states. Yet despite this momentum, the rate of opioid-related deaths in the commonwealth continues to climb — a stark reminder of the human cost of this epidemic. And those rising numbers keep sending us an important message: that's there's no room for complacency, a need for even more vigilance, and a long, long way to go before we can claim real progress.

James S. Gessner, M.D. is president of the Massachusetts Medical Society, the statewide association of physicians with more than 25,000 physician, resident, and medical student members.


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