Chronic Pain Suffers Not Affected By Colorado’s Opioid Prescription Limits, But Hurdles Still Exist

Sep 21, 2018

Lucille is 64 and has chronic back pain because of a genetic condition. She takes two extended release morphine tablets and three to four hydrocodone pills every day. Lucille, who asked us to use an alias to maintain her privacy, is prescribed a 30-day dose of each.

"My husband and I kayak, we snowshoe, we hike regularly, we walk," she said. "I can cook again. So, I have my life back."

Lucile has been taking the medication for a couple years. But she's worried that with so much attention on the opioid crisis her medication could be limited because of a fear that everyone who takes pain pills will become addicted.

"People look at you like, 'Well, there she is. She's either there or she's heading that way.' So, it's embarrassing, it's sad and it makes me angry," said Lucille.

According to national data, more than 40 percent of all U.S. opioid overdose deaths involved prescription pain pills in 2016. To curb the abuse of medication, a patchwork of new regulations have been implemented nationwide.

Insurance companies now have their own set of guidelines, while pharmacies like CVS Health and Walmart also limit prescriptions and dosages. Medicare plans to implement similar changes January 1st.

Colorado, like many other states, also regulates pain pill prescriptions.

Chronic pain is exempted

In May Gov. John Hickenlooper signed Senate Bill 22. The bill limits opioid prescriptions for new patients and those with acute injuries or recent surgeries to seven days. Medical professionals must also check the Prescription Drug Monitoring Program database before writing any refills.

The bill will not affect chronic pain suffers, like Lucille, who need opioid medications on a daily basis to function.

"It's totally up to the discretion of the provider," said Robert Valuck, professor of pharmacy at the University of Colorado Anschutz Medical Campus. "If they say it's chronic pain, then Senate Bill 22 does not apply."

Valuck is also director of the Colorado Consortium for Prescription Drug Abuse Prevention, which was created to address the opioid crisis. The group advised the lawmakers who drafted Senate Bill 22.

The bill wants to reduce the amount of leftover medication.

"The goal is to not have people get a prescription for 80 or 90 of these tablets, end up going home and taking five or eight or whatever and then having 70 left over, "said Valuck. "Which unfortunately has become very common."

Robert Valuck is director of the Colorado Consortium for Prescription Drug Abuse Prevention, the group advised lawmakers who drafted Senate Bill 22.
Credit Skaggs Schools of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Campus.

According to Valuck, 70 percent of people who overdose, go into treatment, or die from opioids, first used the drug with someone's leftover medications. Seventeen percent of people who abuse opioids started with their own remaining opioids and six percent end up with chronic opioid use after being prescribed pain medication for something acute like a surgery.

Another goal of Senate Bill 22 is to educate doctors about their prescribing practices.

"We're not saying don't do it, we're saying be careful if you do it for a long time or it's chronic pain or higher doses or whatever," said Valuck. "Be careful and slowly ratchet up your monitoring accordingly."

Chris Kottenstette, a physician assistant at the Colorado Spine Institute in Johnstown, said the new state regulation is reasonable. But because of the seven-day limit, he has to schedule time for a patient to return a week later. This means he can't see as many patients.

Kottenstette also said his prescriptions aren't being filled.

"I will put (on the prescription) 'patient's pain is expected to last longer than 14 days,' which should allow that prescription to be filled according to the way it was written," he said. "The issue is, is that they still won't fill it. Again, it's a seven-day return."

Patients caught in the middle

Lucille is not directly impacted by Senate Bill 22, but she has run into issues with some of the other opioid prescription regulations that are in place.

Lucille has excellent insurance that covers her thirty-day supply of drugs. But she's had to pay out of pocket before because they wouldn't cover an early refill - even though she had a new prescription for the change.

"It also irritates me that insurance companies and pharmacies have superseded my relationship with my doctor," she said. "He sees me monthly, he sees my MRIs, he knows my medical conditions."

All the state and federal laws and pharmacy and insurance regulations have been enacted to stop opioid abuse, overdose and deaths. But even with the best of intentions, Valuck said patients are getting caught in the middle.

"There's all this stuff going on, and its very confusing and it's very difficult for patients to know what they're supposed to do here," he said.

Kottenstette, who is Lucille's physician assistant, said if the different restrictions prevent patients who suffer from chronic pain from getting their medications, the consequences could be dire.

"Through no fault of their own, they go into withdrawal or have secondary side-effects, and then you have to start over," he said. "The other issue with not having these medicines is people lose their tolerance for the medication."

Limiting pain pill prescriptions is only one piece of the state's plan to stop opioid abuse. Hickenlooper also signed bills that address insurance reform, prevention and treatment.