Lawmaker says opioid dossage best left to doctor’s discretion
PHOENIX -- Rep. Jay Lawrence is declaring his own war against the governor’s war on opioids.
The Scottsdale Republican wants to make it illegal for any state or local government or agency to limit the amount of regulated painkillers that physicians can prescribe at any one time. He said that’s an issue best left to doctors and their patients.
But the timing of HB 2030 is no accident. It comes as Gov. Doug Ducey is preparing his own legislation going in precisely the opposite direction.
State health Director Cara Christ said earlier this year she would limit prescriptions for what she calls “opioid naive’’ patients -- those who have not been taking opiates in the past three to six months -- to a pill supply of no more than five days.
But that’s not all.
Christ said Arizona law should have a limit on daily dosages to less than 90 “morphine milligram equivalents.’’ That’s the same as 90 milligrams of hydrocodone or 60 milligrams of oxycodone.
The CDC reports that the risk of overdose doubles above 50 MME a day.
Lawrence said Ducey is off base.
“I do not believe that government can step in to tell the medical profession and tell medical doctors what is correct to prescribe,’’ he said.
The legislation drew a sharp response from gubernatorial press aide Daniel Scarpinato. He said the problem has reached epidemic proportions and state intervention is necessary.
“In the last year we’ve had hundreds of people die ... from opioid-related overdoses,’’ he said. “That’s a huge number of people.’’
And Scarpinato said the trend is increasing.
“So, absolutely, something more needs to be done here,’’ he said.
More to the point, Scarpinato said it’s not like Ducey is seeking to impose some restrictions over the objections of doctors. He said many physicians are involved in crafting a final plan.
That’s also the position of the Arizona Medical Association.
Pele Peacock Fischer, vice president for policy and political affairs for the organization, said it is is “committed to actively participating in the governor’s stakeholder process and focusing on the comprehensive legislation expected from it.’’ And she said her organization did not ask Lawrence -- or anyone else -- to introduce their own legislation about opioid dosages or prescribing limits.
But Fischer stopped short of endorsing what Christ had proposed earlier this year.
“We look forward to seeing a bill draft and continuing to work with the governor’s office and legislators to find appropriate solutions,’’ she said.
Lawrence said he is not disputing that there is a problem.
But he said he’s not convinced that hard and fast limits are appropriate. Instead, Lawrence said, the key is physician oversight.
“I believe we have enough disciplines in place,’’ he said. “And I want to to see those disciplines in place so we know who is prescribing, how much they’re prescribing, and if someone is shopping doctors.’’
Scarpinato said the governor believes that oversight, by itself, is not enough.
He said the record in Arizona proves that, pointing to reports that four doctors in Mohave County prescribed six million doses of opioids in one year. That includes one doctor who wrote 20,232 prescriptions amounting to more than 1.9 million pills, or about 7,350 a day.
That’s in a county with about 210,000 people, though there is some question whether the proximity to Las Vegas figured in that.
“We need to give law enforcement the tools in law to be able to hold them accountable,’’ Scarpinato said.
Scarpinato acknowledged what the governor wants appears at odds with his repeated calls for less regulation. But he said Ducey’s concern is removing barriers that keep people from working. This, Scarpinato said, is different.
“We’re not talking about blow-drying hair,’’ he said. “We’re talking about drugs that can be miracle drugs for some but are very addictive and we’ve seen can lead to death.’’
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