InHealth: Pain on the Suncoast-Legislating Responsible Prescribing

By Dr. Fabian A. Ramos

On Monday, March 19, Governor Rick Scott signed Florida House Bill 21 at the Manatee County Sheriff’s Office, allocating more than $65 million to tackle Florida’s continuing opioid problem – an epidemic that ravages our population. According to a report recently released by the Florida Department of Law Enforcement, 5,725 people overdosed in 2016, an increase of nearly 35 percent from 2015. Of those, substances that are not prescribed by doctors, such as heroin and carfentanyl, accounted for 406 and 754, respectively. These harrowing numbers pointed to the urgency of prescription reform. opioid

HB 21 goes into effect on July 1, 2018, to enact measures that help regulate acute and chronic pain prescriptions of opioids by imposing three main components:

1.   Opioid prescriptions written to treat acute pain will be limited to only a three-, seven-, or 10-day opioid prescription when deemed medically necessary. 

2.   Mandatory physician review of the E-FORCSE (Electronic Florida Online Reporting of Controlled Substances Evaluation) database to determine a patient’s current prescribed medications prior to writing new prescriptions for controlled substances.

3.   Authorized physicians are required to complete a board-approved, two-hour continuing education course on prescribing controlled substances. opioid

It is important to understand the difference between acute and chronic pain. Acute pain will subside. Chronic pain is ongoing and often debilitating. One may experience acute pain after a dental procedure, minor injury or surgery. With the new legislation, those suffering from acute pain will be limited to prescription dosages as mentioned above. 

In a prior step to combat opioid abuse, the Florida legislature created E-FORCSE in 2009 to encourage safer prescribing. As you fill a prescription for a painkiller or opioid, your pharmacist is required to log this data into E-FORCSE. Although the information has been available, it has not been mandatory for all physicians to refer to this database prior to writing a prescription for a controlled substance. When the legislation is enacted, this will be mandated by law.

Another element of responsible dissemination of controlled substances by physicians relates to MME (Morphine Milligram Equivalent) per day. This affects those suffering from both acute and chronic pain. The effective milligram dosages has be lowered with the new legislation; another necessary step in proactively managing the risk of instances of addiction and overdose.

Will these new requirements be easy to implement? No. 

Will this new legislation be convenient for doctors and patients alike? No.

Will these new requirements save lives? Yes.

With HB 21, the State of Florida is taking steps to curb the opioid epidemic and urge a conservative approach to pain management that focuses on other modalities and interventional procedures. Prescribing opioids should be a last resort. For example, in a practice like the Ramos Center, which serves over 10,000 patients, only 18 percent of the patients are prescribed opioids – and only when deemed absolutely necessary, such as a patient who is diagnosed with intractable pain. 

There has been a renaissance over the past two decades with the closure of many “pill mills” on the Suncoast. As a result, Manatee County Sheriff Rick Wells reports that in the last six months of 2017, there was a 75 percent decrease in overdoses and deaths, and an 85 percent decrease thus far in 2018. When HB 21 is enacted this summer, we expect an even greater decrease in negative opioid-related consequences.

Fabian A. Ramos, MD, FIPP, DABA, DABIPP, DABPM
Ramos Center forInterventional & Functional Pain Medicine
100 3rd Avenue West, Bradenton
5741 Bee Ridge Rd., Sarasota
941.708.9555