PROVIDENCE, R.I. — Rhode Island is one of five states that enacted limits on first-time opioid prescriptions this year after the U.S. Centers for Disease Control and Prevention called for even tighter restrictions.
The rules were among a package of bills pushed by lawmakers and Democratic Gov. Gina Raimondo’s Overdose Prevention and Intervention Task Force, and they are meant to provide a comprehensive approach to the opioid overdose crisis. In addition to the limits on first-time prescriptions, the package included provisions meant to require better follow-up care and treatment options for people with substance abuse problems, improve monitoring of opioid prescriptions and better insurance coverage for opioid overdose antidote drugs and alternative therapies such as acupuncture.
The new rules restrict initial prescriptions for outpatient adults to 20 doses of 30 morphine milligram equivalents each. The rules do not apply to patients with pain associated with cancer, or to palliative or nursing home care, and apply only to those with acute, not chronic, pain.
Nicole Alexander-Scott, director of the state Department of Health, said doctors were taught years ago that opioids were a safe way to treat pain, and the goal was for patients to be completely pain-free.
“It was normal to give a 30-day course for someone who only needed it for three days,” she said. “What we’re hoping to do with this legislation is to change the cultural dynamic. It is not safe to give people extra opioids if they don’t need it.”
Now, she said, the goal is to help patients live active lives while functioning with pain. That’s where alternatives such as acupuncture, physical therapy and massage come in, she said.
Connecticut, Maine, Massachusetts and New York passed similar restrictions, all with exceptions for patients with chronic pain. Alexander-Scott said the exception for chronic pain is an important one.
“Now that people are addicted, we can’t just cut them off,” she said.
Other aspects of the legislative package aim to create options for people who are already addicted and need help with treatment, she said.
In Rhode Island, nearly 1,700 people died of drug overdose from 2006 through 2014, according to the U.S. Centers for Disease Control and Prevention. In 2014, the rate of drug overdose deaths amounted to 23.4 people per 100,000 residents, the sixth-highest rate in the country. The CDC has indicated that prescription opioids and heroin account for the majority of drug deaths.
A joint investigation by The Associated Press and the Center for Public Integrity found that drugmakers that produce opioid painkillers and allied advocacy groups spent more than $880 million on campaign contributions and lobbying over the past decade as they worked to influence state and federal policies.
The investigation found approximately $20,000 of that was spent on contributions to state parties or candidates for state office between 2006 and 2015 in Rhode Island, which ranked 48th among states for the amount of spending.