Florida’s new law on controlled substance prescribing went into effect on July 1, but is already producing significant results, state health department officials told the Senate Health Policy Committee this week.
Adopted during the 2018 session as House Bill 21, the law makes it mandatory – rather than voluntary – for both prescribers and dispensers of pharmaceutical opioids to check with the state’s Prescription Drug Monitoring Program (PDMP) database before distributing a controlled substance.
HB 21 now requires pharmacists and dispensing practitioners to report prescriptions within seven days each time they dispense a controlled substance to the state’s PDMP, which was established in 2009 but will become an increasingly more valuable tool as mandatory participation boosts its utility.
As a result, according to a presentation delivered by state officials, there has been a 15.5 percent reduction in patients receiving schedule II opioids since 2017.
The Senate Health Policy Committee is among a number of panels meeting this week in Tallahassee for primers on pivotal issues lawmakers will confront when the 2019 legislative session kicks off on March 5.
The committee, which also heard a presentation from state Medicaid Director Beth Kidder on the status of Florida’s $26 billion Medicaid program, did not discuss any tentative proposals from the DeSantis’ Transition Advisory Committee on Health and Wellness.
Among recommendations the panel is expected to forward is expanding telemedicine, improving hospital and provider reimbursements, and dedicating more resources for mental health and behavioral services, particularly in rural areas.
Several advisory committee members also want to expand the state’s Medicaid program to provide more coverage for substance-use disorders by amending one of two “waivers” to extend eligibility for people who suffer from substance-use disorders.
The opioid prescription law created by adoption of HB 21 is part of the state’s response to the opioid epidemic, which the Florida Department of Law Enforcement claims was responsible for 5,700 deaths in 2016.
In addition to making PDMP reporting mandatory for prescribers and dispensers, the new law includes three-day limits for Schedule II opioids such as codeine, hydrocodone, Demerol, Dilaudid and Percocet.
From the last quarter of 2017 through first three quarters of 2018, according to the AHCA, there has been a 15.5 percent reduction in patients receiving schedule II opioid drugs and an 8.69 percent reduction in hydrocodone SA prescriptions dispensed as documented by the PDMP.
The new reporting requirements may actually be working too well, the Florida Hospice and Palliative Care Association maintains, noting it will lobby for a 2018 bill to exempt physicians serving hospice and palliative care patients from HB 21.
There were 137,351 people in a Florida hospice in 2017, Dr. Stephen Leedy, a board-certified hospice and palliative care physician, told the committee. On average, each have seven medication changes in the first 48 hours and as many as 20 during their end-of-life hospice stays, which averaged about three weeks.
“They were not out there doctor-shopping,” he said, noting end-of-life pain management can require six to seven opioid dosages a day.
Each and every one now requires a submission and query to the PDMP, Leedy said, a time-consuming nuisance compounded by answering the same battery of red flag questions raised by prescription frequencies and dosages that only cause patients to unnecessarily suffer at the end of life.
“We’ll look into it,” Senate Health Policy Chairwoman Gayle Harrell, R-Stuart, promised.