DEA may change prescription rules

Pain experts and patients alike hope the Drug Enforcement Administration will again let doctors write up to three prescriptions with staggered fill dates for Schedule II controlled substances. The proposed rule change, which is expected to win approval, would allow what amounts to a roughly three-month supply of pain medicine, filled one month at a time.

During the public comment period, which closed recently, the American Academy of Pain Medicine came out strongly in favor of the change. Currently, people with chronic severe pain who need opioid medications must present a new written prescription at the pharmacy each month — something they have to keep arranging with a physician— and no refills are allowed.

That's a burden for patients, especially if they live far away from the doctor's office, says Dr. Perry Fine, a board member for the academy who is also a professor of anesthesiology at the University of Utah and vice president of medical affairs of the National Hospice and Palliative Care Organization. He says having to make a trip specifically to arrange for a prescription or have one mailed is cumbersome — especially for those who must travel a ways, common in the Intermountain West.

Marcia Solum of Layton makes the journey about twice a month. She suffered for years with intractable back pain that various treatments, including two surgeries, failed to relieve. Finally, she was placed on a morphine pump that reduces the pain to a "5", she said, and given a prescription for an oral controlled substance. The morphine is filled for 31 days at a time, while the pill prescription is for 28 days. Nothing ever matches up, she says, so she must make multiple trips to the doctor to get prescription forms.

The new rule, she says, "would be fabulous." Doctor visits not medically necessarily — and their cost — could be eliminated.

"Sometimes getting more (medication) is a burden that there's no way to shortcut," Fine says. "But if the patient is well-known to us and is clearly adhering" to instructions, the single-prescription rule just creates added work for patients.

Since no refills are allowed, that new prescription has to be timed so they're at the end of one, but won't have to do without. And unlike other medications, the pharmacist can't just call the physician and ask for permission to refill a controlled substance prescription.

It's a problem, Fine said, created because drugs like opioids have important medical use but also potential for dependence and abuse.