As part of the effort to combat what many consider an epidemic of opioid addiction, the Oklahoma Legislature passed Senate Bill 1446, which was signed into law by Gov. Mary Fallin.
The bill's provisions go into effect Nov. 1, and some patients are concerned about their access to painkillers, especially in conjunction with other drugs like Xanax.
"If a patient is not abusing either of the drugs, there is absolutely no reason to pull them off either," said Cherry L. Candy, 72, who has been on a regimen of Xanax and opioids since she was severely injured in a traffic collision in the 1990s.
The crash killed her son and left her with a disfigured and mostly incapacitated right arm. She added that she suffers from congestive heart failure, diabetes, osteoarthritis, rheumatoid arthritis and lupus.
Candy said she has undergone benzodiazepine withdrawal on multiple occasions, during which she endured vivid flashbacks to the collision. She says those are due to PTSD and acute anxiety. Under the new law, she cannot receive concurrent Xanax and opioid prescriptions.
"I believe this will kill me," Candy said. "I'm not the only one. This will kill a lot of senior citizens. I need my pain pills for my arm and back. I think it could turn people to heroin and cause a new epidemic. All I can do is have faith in my God that I will get through this, and if not, to take me home, because I am ready. "
SB 1446 mandates the Board of Medical Licensure require an hour of education annually in pain management or opioid use and addiction before applying or renewing for a license, unless the licensee has demonstrated to the board that he or she does not currently hold a valid DEA registration number. It also modifies the definition of "unprofessional conduct" by including the prescribing, dispensing or administering of opioid drugs in excess of authorized maximum dosages, an adds definitions as used in the Uniform Controlled Dangerous Substances Act relating to opioid prescription.
The new law deems any failure to consult the central repository as grounds for disciplinary action. It also allows the Oklahoma Bureau of Narcotics and Dangerous Drugs to make unsolicited notifications to the licensing boards of a pharmacist or doctor. Initial prescriptions for opioids are limited to a seven-day supply. The course of treatment for any patient who is continuously prescribed an opioid or other Schedule II controlled substance for three months must be reviewed.
Definitions of "acute pain" and "chronic pain" are outlined, and exceptions are allowed for patients who have cancer, or for terminal or palliative care. There are also exceptions for hospice patients and those living in "long-term care facilities." The Oklahoma State Department of Health long-term care facilities as "nursing homes, skilled nursing facilities, residential care homes, assisted living centers, continuum of care homes (which include an assisted living center and a nursing facility) and Intermediate Care Facilities for Individuals with Intellectual Disabilities."
More peripherally, SB 1446 requires the state insurance department to evaluate the effect of the opioid prescription limitations on claims paid by health insurance carriers.
"I think it is a well-intentioned law, but I have some reservations," said Dr. Kenneth Gibson, a local specialist in pain management and addiction. "Some doctors may decide not to prescribe at all."
Gibson expressed understanding about lawmakers' concerns. He explained how a doctor would comply with the law.
"For acute injury or pain, you can only write a prescription for up to seven days," Gibson said. "I have to warn the patient that, even if taken properly, opioids can be addictive. You cannot use them with alcohol or 'benzos.' I have to explain the other options to opioids. It has to be documented."
If a patient returns with acute pain, Gibson said a doctor can write another seven-day prescription. Afterward, there is a controlled substance agreement. It specifies pill counts and drug screens, and the doctor must see the patient once a month.
"There is credibility to trying other options," Gibson said. "Under this law, a doctor has to take time to discuss other options like lidocaine patches or voltaren gel - or ice, heat, stretching and weight loss, or physical therapy. If it is getting worse, let's x-ray it. Maybe there is a procedure we can do."