Editor’s Note: This story has been corrected to reflect that Larson’s ideas would not affect chronic pain sufferers.
One of the University of New Mexico’s top administrators says tackling the national opioid addiction epidemic will require governmental regulation, including prescribing restrictions that have raised concern among some medical professionals.
In a recent opinion piece for The Wall Street Journal, Dr. Richard Larson argues for imposing controls on opioid prescribing, writing that “without strict government regulation, (overprescribing) won’t be solved.” The UNM Health Sciences executive vice chancellor supports a three-day limit on outpatient prescriptions for acute pain and prohibiting opioid prescriptions for adolescents. He contends the federal government could stake Medicaid and Medicare reimbursements on adherence.
Larson also says health care systems should have opioid stewardship programs to monitor physicians’ prescribing practices, citing the efficacy of similar systems in the case of antibiotics.
Larson – who stipulated these were his opinions and not UNM’s – does not currently see patients, but said he collaborated with Dr. Daniel Duhigg on the piece. Duhigg is the program medical director for behavioral health at Presbyterian Healthcare Services.
The number of opioids prescribed in the U.S. nearly quadrupled between 1999 and 2014, according to the Centers for Disease Control and Prevention. Prescription opioids are involved in 40-plus overdoses per day, the CDC says.
Larson says his position jibes with CDC guidance; in prescribing opioids for acute pain, the CDC recommends the lowest possible dose and says three days’ worth usually suffices.
But Dr. Halena Gazelka, who practices pain medicine at the Mayo Clinic, countered Larson in an accompanying editorial, arguing that strict regulation could leave many patients in pain. She instead promoted better opioid-related education inside health systems and medical schools.
“Dictating physicians’ behavior should be limited to requiring education on the risks of long-term opioid use and proactive strategies for responsible prescribing,” she wrote.
The American Medical Association also has questioned the appropriateness of three-day supply limits.
Larson cited with concern his personal experience with outpatient surgery and a periodontal procedure. Prior to each and with no consultation with the providers, he received hydrocodone prescriptions.
“Research shows that the seemingly compassionate use of opioids to minimize pain in minor medical procedures like these ultimately increases the number of chronic opioid users and overdoses,” he wrote.
Larson said in an interview there “hasn’t been enough distinction” between opioid treatment for acute and chronic pain. He said the restrictions would not apply to chronic pain sufferers.
“There’s a very, very big difference between the number of people with chronic pain who need it and those with acute pain who could potentially get by with either very short prescriptions or no prescription at all,” he said.