Doctors began doling out opioid prescriptions in the 1990s under the guidance of pharmaceutical companies who promised the painkillers weren’t addictive. Now, a key part of tackling the drug epidemic sweeping the country is reining in the prescription pad.
But in Virginia, some nurse practitioners say the state’s opioid prescription regulations are too strict and could stop patients with severe pain from getting the treatment they need.
In 2017, Virginia adopted emergency regulations for prescribing the narcotic painkillers in an attempt to stem the ongoing opioid epidemic, which killed 1,229 people in the state last year, according to the state Office of the Chief Medical Examiner.
The regulations include rules on how often providers can prescribe opioid painkillers and how long those prescriptions can last. They apply to all providers, like physicians and dentists, and right now the Board of Nursing and the Board of Medicine are in the process of making them permanent. As emergency regulations, they’re due to expire in November.
The comment period for the proposed permanent regulations for nurse practitioners is due to end Sept. 7.
During a recent Board of Nursing meeting, Winifred Y. Carson-Smith, a lawyer representing the Virginia Council of Nurse Practitioners, said the regulations are more demanding and onerous than similar rules in other states.
“We believe, if implemented, these regulations will impede nurse practitioners’ ability to properly diagnose and relieve pain,” she said. “There’s no documentation that controlling prescribing in this limited, narrow fashion will reduce opioid drug use.”
Essentially, Virginia can do better, said Cindy Fagan, the council’s government relations chair. And that doesn’t just apply to nurse practitioners, she added. Other prescribing providers are also unnecessarily limited under the regulations.
Carson-Smith said Virginia’s rules are too narrow because there are always exceptions to how people respond and react to pain, and treatment needs to be individualized. Other states, like Washington, have models that encourage providers to properly diagnose pain and treat it accordingly using a range of treatments.
Many providers have raised similar concerns across the country. They say that cutting off patients too abruptly from pain medication could have unintended consequences, such as pushing patients to other illicit options, such as heroin.
According to the National Institute on Drug Abuse, 80 percent of people who use heroin began by abusing a prescription opioid.
Last year, heroin resulted in 558 fatal overdoses in Virginia, and so far this year it’s caused 542. By contrast, opioid painkillers like OxyContin and Vicodin caused 507 fatal overdoses in 2017. And the numbers are just getting worse. So far this year, opioid prescriptions have killed 517 people.
But as nurse practitioners claim the regulations could harm patients, others argue that safeguards to prevent overprescribing are especially necessary to protect patients in light of other changes to Virginia’s health care landscape.
During the past General Assembly session, state lawmakers allowed nurse practitioners to practice independently of a supervising physician. Ralston King, assistant vice president of government affairs with the Medical Society of Virginia, said that means there should be strict regulations to ensure nurse practitioners don’t prescribe too many painkillers.
“Physicians are still concerned about nurse practitioners being out there practicing autonomously, and we have to make sure there are safeguards, because if we don’t there will be no patient protections,” King said.
There are times when complex patients with pain issues do require specific treatment plans, he said. And that’s when a doctor should be involved, not a nurse practitioner.
While they work on making the regulations for nurse practitioners to prescribe opioids permanent, both the boards of nursing and medicine are working simultaneously to develop the rules governing nurse practitioners once they start practicing independently.
King pointed out that opioid prescriptions have fallen. According to the state’s Prescription Drug Monitoring Program, from the end of 2016 to mid 2017 there was a 40 percent decline in the number of pain reliever prescriptions.
“We want to make sure that trend continues to go downward and we want to make sure the individuals who have the ability to prescribe know what they’re doing,” King said.
But Fagan, with the Virginia Council of Nurse Practitioners, pointed out that nurse practitioners must meet the same continuing education criteria required under Virginia law to prescribe opioids as physicians, and that they must also use the state’s prescription monitoring program to ensure patients aren’t misusing the drugs.