Opioid epidemic prompting prescription changes

Dr. Charles Miles
Staff Writer

The opioid epidemic has gotten so bad in Mississippi and other states that doctors are beginning to make their patients sign waivers agreeing to take random drug tests if the doctor suspects the patient may be abusing the drugs or diverting them to others.

It's one of several changes the state medical licensing board, nursing board and pharmacists are talking about with the Legislature to try to get a handle on the problem.

"We're trying to get our hands around the problem, looking at all kinds of options," said Dr. Charles Miles, a West Point gynecologist and obstetrician who is on the State Board of Medical Licensure.
The board is meeting with legislators and other medical groups this week to try to finalize some proposals.

"The problem is people who are in chronic pain, pain that last for more than six months. We are going to ask for a urine screen three times a year to make sure the drugs aren't being abused one way or the other. If you suspect something is up, like you give a 30-day prescription and they are back in 10 days because the dog ate the pills, then you might ask sooner," Miles explained of some of the options being considered.

Other changes are limiting prescriptions for pain killers after surgeries to three days or a maximum of 10 days so the doctor can meet with the patient and refill the prescription if needed.

"The problem with opioids is that if you are on them for 20 days or more, the addiction risk increases significantly. And many of the opioid addicts got started with a legitimate prescription. That's what we are trying to balance and it is a balancing act," Miles continued, noting the number of opioid prescriptions written in the state dropped 6 percent last year, but the number of pills actually increased.
Some doctors already have taken steps to better monitor their patients. And patients still are adjusting to those changes, setting the stage for reactions as the state debates new rules.

For instance, Columbus resident Brennan Stanford's doctor recently made her sign a statement agreeing to random drug tests if he suspected she was mishandling her Xanax prescription. He also makes her come in for appointments every two months to get new prescriptions. Up until recently he could write six months worth of prescriptions at a time. But new rules limited that to three months and her doctor has taken it one step further.

"I understand it, I may not necessarily like it, but I understand it," Stanford said. "I just think it is sad it is coming to things like this, that doctors can't even use their best judgment.

"And in my case, it means two more trips to the doctor every six months, that's $50 more in co-pays. Not everyone can afford that," she continued.

"It sounds like he is just being proactive with all his patients. It's part of the balancing act," Miles said of the doctor, noting one of the issues with Xanax is mixing it with potent pain killers like oxycontin, Lortab, and Percoset.

The extra cost is a big issue for others, too.

"I signed it because I had to. And I've had friends who are addicts. But there's got to be a balance somewhere. I can't afford to pay for extra doctor visits, not with a $40 co-pay. And I probably am better off than some people. I think that is going to be an issue before it's all said and done," said Starkville resident Bud Adamson, whose doctor also has imposed stricter prescription guidelines and potential drug testing.

"The drug test is just a nuisance and I doubt I ever will have to take one because I take my medicines like I'm supposed to. But who is going to pay for those extra drug tests? Me, the insurance company? This only adding to medical costs and health care is too expensive as it is. I tell you what, I am a whole lot more careful about keeping my meds locked up or hidden if people are around," Adamson added.

Those and a number of other questions are being discussed this week in Jackson, Miles said. But addressing a problem that has its roots more than 20 years ago makes it even more difficult.

"In the 1990s, the federal government told doctors we weren't doing enough to properly treat pain. It became the fifth vital sign. At about the same time, drug companies came out with oxycontin. I can remember reps in my office talking about how it had no side effects, how it was the perfect drug...no side effects other than it is highly addictive. That's when the opioid crisis got started," Miles recalled.

The issues behind the opioid are many. But money certainly plays a role. At the pharmacy, an oxycontin tablet is about 25 cents. On the street, a pill sells for $86.

"It's easy to see why people are stealing them, taking them from their mothers and grandmothers," Miles said.

Drug enforcement agents welcome the medical community's involvement.

"That's where in the long run we can do more to stop the cycle, or at least slow it down. It takes everyone communicating. It may inconvenience some people, bu the problem is costing us all right now, trust me. And it's killing people," said Capt. Archie Williams, who heads the Lowndes County Drug Task Force.

In addition to prescription limits, drug testing, and increased patient monitoring, other potential changes include more requirements on pharmacies and better cross-referencing among all medical fields -- doctors pharmacists, hospitals, and clinics.

"We have a database to check to make sure people aren't double- or triple-dipping with charities. Certainly we can do the same thing with doctors and pharmacies and prescriptions," Stanford said in frustration.

"A lot of people are going to have to be part of the solution. But legislators have been very cooperative so far. They understand we have a serious problem," Miles concluded.