Testimony In Support of S.1040, An Act Creating Patient Choice and Education In Dispensing Of Opiate Drugs

Before The Joint Committee on Mental Health and Substance Abuse

The Massachusetts Medical Society (MMS) wishes to be recorded in support of S. 1040, An Act creating patient choice and education in dispensing of opiate drugs.

The MMS shares Sen. Keenan’s goal of reducing the number of opioids prescribed in the Commonwealth. Prescriptions that are larger than necessary can lead to opioid dependence and misuse. The Centers for Disease Control and Prevention noted that 80% of persons misusing opioids did not receive the drugs from a valid prescription. Limiting certain high volume prescriptions through partially filled prescriptions can also limit the diversion of unused drugs.  

The MMS has directly addressed the issue of responsible prescribing through the development of prescribing guidelines for opioid therapies. At the heart of these guidelines is a recommendation that “the starting dose should be the minimum necessary to achieve the desired level of pain control and to avoid excessive side effects.” The MMS is continuing to promote this recommendation through physician outreach and continuing medical education. The reality of complex pharmacology and pain management, however, is that the minimum effective dosage can be difficult to determine and is often a moving target. Additionally, prescriptions issued for post-operative or post-procedural pain cannot anticipate the exact nature of recovery and subsequent pain. The Medical Society believes that “partial fill” policies are an important element to lowering the volume of opioids dispensed at pharmacies in instances where the lowest effective dosage is difficult to determine.

We support this bill with the anticipated amendment from the sponsor to ensure that the remainder of a prescription that has been partially filled remains valid. This is an important consideration to ensure that this does not lead to excessive, unnecessary follow-up care to obtain the remainder of an original prescription. It is also an important inducement to the patient.- Many more patients would be willing to receive only part of their opioid prescription if they knew they could return for the remainder if the pain persists. The MMS also believes that a crucial component to this legislation is communication about the partially filled prescriptions. We commend Sen. Keenan for including a requirement that pharmacists communicate to physicians whenever a prescription is partially filled. We also think that it is important that the proposed law will ensure that the total copayments paid by a patient receiving partial fills does not exceed the amount of copayments for an initial, total fill. Lastly, we hope that the legislature or responsible regulatory agency will seek confirmation from the relevant federal agencies to clarify any compliance issues related to this initiative.

The Medical Society support the idea of empowering patients to receive partial fills of opioid prescriptions while allowing for them to return to receive the remainder of the prescription if pain persists. We hope this will lead to fewer extra drugs from being prescribed. 

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