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Time to Put Limits on Opioid Prescribing

July 12, 2017

This op-ed authored by Larry Merlo, President and CEO of CVS Health, was published by Morning Consult on July 11, 2017.

Across the country, too many of us have experienced an alarming and heartbreaking trend — the growing number of people in our everyday lives who have been affected by the epidemic of opioid addiction and misuse. Whether it’s a colleague’s son or a neighbor’s sister, the heartbreaking stories about lives fractured by the grips of addiction are far too common. This epidemic has no single cause and it doesn’t discriminate. It exists in our cities, in the suburbs and across rural America.

A recent survey found that nearly 1 in every 3 people in the U.S. has been personally affected by the issue of prescription drug abuse. Nearly 40 percent of people said the number of people they know who have been personally impacted by prescription drug abuse in the last year has increased. A vast majority of people, nearly 90 percent, agreed that prescription drug abuse is a problem and more than half believe it is getting worse.

Recently, newly confirmed Food and Drug Administration Commissioner Scott Gottlieb personally wrote to the 18,000 employees at the FDA calling for “more forceful” efforts to combat this epidemic and challenging them, among other actions, to consider ways to assure that the number of opioid doses that an individual patient can be prescribed is more closely tailored to the medical indication. He’s right. Bold action is needed to address this crisis. Without a doubt, it will require a multi-pronged effort involving many health care stakeholders — from physicians and pharmaceutical companies to pharmacies and government officials.

Last year the Centers for Disease Control and Prevention issued guidelines for prescribing opioids for chronic pain. That was definitely a step in the right direction, but those guidelines only addressed chronic pain and not short-term, acute uses for pain medication. And an individual pharmacist is not empowered to enforce these voluntary prescribing guidelines.

As a leading stakeholder in pharmacy care, we believe it is time to institute limits on the quantity of opioids dispensed to patients who are receiving an opioid for the first time — and to ensure that the prescription fits the medical condition. Even physicians and proponents of pain relief with opioid painkillers who supported changes in clinical practice some twenty years ago that significantly increased prescribing of opioids agree that these practices now must be changed.

At least one recent study suggests that there is a correlation between the number of pills given on first prescription and the likelihood of addiction. Common sense tells us that overprescribing increases the risk of addiction for the patient, but also for family members when there are extra pills left in the house.

An ankle sprain or dental procedure does not call for a prescription of 30 or 60 powerful pain pills. We strongly endorse efforts by legislators and regulators to limit those prescriptions to a much more moderate — and appropriate — supply.

Pharmacies can play an important role in helping ensure appropriate access to pain medications while assuring patient safety. Electronic or e-prescribing for controlled substances has proven to be effective in reducing drug diversion and fraud. Requiring physicians to send controlled substance prescriptions to the pharmacy using this method, which is already the practice in some states, should be made a nationwide practice.

We must also continue to prioritize prevention and education among our patients and their families. Over the past three years, CVS pharmacists have volunteered to speak at schools all across the country, educating more than 250,000 students about the dangers of prescription drug abuse. And we have worked with 41 states to expand access to the opioid overdose reversal drug Narcan, with the goal of saving lives and giving people a chance to get the help they need for recovery.

Getting dangerous and unused medication out of people’s homes is also a priority. CVS Health has worked with local law enforcement around the country to collect more than 80 metric tons, or 175,000 pounds, of unwanted medication that could otherwise be diverted, misused or end up in our water supply.

Nothing in this should suggest that there aren’t patients in real need of pain medication — and legislation must be tailored so as not to impair access for cancer patients or others with critical need — but at the same time we must protect the next generation of patients who have been dispensed too much medication for too little cause.

For more information about our efforts in the fight against opioid abuse, visit our Prescription Drug Abuse information center. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.