Doctors: New opioid rules 'unrealistic'

Some Vermont doctors fear new rules regulating opioid prescriptions are out of touch with patients' needs.

The new state rules go into effect July 1. Health care professionals who attended a meeting at the University of Vermont Medical Center in Burlington this week voiced mixed reactions.

The revisions to existing rules are meant to minimize opportunities for opioid misuse, addiction and overdoses. They also require doctors to assess non-opioid and non-drug treatments before opioids are prescribed and to talk through treatment decisions with their patients.

According to the Vermont Department of Health, the rules set a framework for prescribing opioids to deal with pain. Each level of the framework limits the number of pills that can be prescribed to the minimum amount that would be effective in managing pain.

Dr. Richard Cordero, a surgeon who works in both the dental and medical worlds, said after the meeting that he found the new rules "unrealistic" and "to some extent, disconnected from what the average person experiences." Cordero was one of about 100 people who attended the presentation.

Cordero said he was frustrated with the rule that un-diagnosed dental pain and molar removal pain fell into a category where no opioids would be prescribed to manage pain. He said the rules are not specific enough to deal with different levels of dental pain as this type of pain has all been classified as "minor pain."

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Cordero told the crowd during the meeting that he's gotten threats from patients with whom he has been strict about prescribing opiates for acute dental pain.

"I've had patients tell me they're going to report me because they think I'm not treating them as they feel they should be treated," Cordero added after the meeting. He said the public may have a difficult time understanding and accepting the new regulations regarding dental pain.

Cordero said he felt that people from his field, though present for discussions on how to craft the new rules, were "essentially ignored."

Orthopedic surgeon Douglas Campbell said after the meeting that he thought the program was good overall, but he is concerned about how the new rules would be rolled out to the public. Department of Health officials in the meeting  said they had  started outreach and education to patients  about the new rules.

"I do think it will really help to educate patients on appropriate opiate usage, and that's good," Campbell said. "I think this could be somewhat confusing to families until they get accustomed to it."

He added, "I think they might sense there is an insensitivity to pain control, and I think that's not the case. It's the protection of the patient against the horrors of opiate addiction or opiate overuse."

Fellow orthopedic surgeon Andy Kaplan said patients who are in pain from surgery may be poorly served by the new system because physicians will have to rely on the framework rather than their own judgement.

"I appreciate the goals of the committee and the importance of their work," Kaplan said. "I expect them to have a major public roll-out to inform the local population, or that will be an abdication of duties. I think this will be very difficult to manage for the surgeons trying to treat a small percentage, but significant percentage, of our patients."

Recently appointed Health Department Commissioner Dr. Mark Levine said he was optimistic about the new rules and thinks that members of the public will end up better educated as to risks associated with pain management through prescription opioids.

Levine said he had anticipated getting a number of questions during the meeting Tuesday because some of the new rules are complex and he felt that some of the health care providers needed reassurance.

"My sense was that there was a mixture of curiosity, a mixture of anxiety and a mixture of people who were worried that this might affect their freedom in prescribing opioids to those who really should have them based on their medical condition," Levine, who works in the internal medicine field, said.

Levine said he realizes that some patients will be frustrated by the new rules and may feel like they're not being treated as aggressively as they have in the past. However, he said that in his experience, many of his patients have accepted alternatives to prescription opioids after he has explained all options in addition to the risks associated with using opioids.

"If we look at the data that says four out of five heroin addicts actually began with the prescription drug route, we can make an impact on that," Levine said. "I think that, along with many other things being done throughout other sectors will help us get ahead of this."

The new rules for prescribing opioids can be found here.

Contact Elizabeth Murray at 651-4835 or emurray@freepressmedia.com. Follow her on Twitter at @LizMurrayBFP.