New 7-day opioid law will burden Michigan's patients, doctors | Opinion

Dr. Jason Schwalb | Detroit Free Press

As of July 1, I will be prohibited by state law from prescribing more than a seven-day supply of an opioid for acute pain.

I also will be prohibited from postdating prescriptions; so, if I discharge a patient from the hospital on a Saturday and give them a prescription for an opioid, I cannot legally write a new one until the following Sunday.

It doesn’t matter if my patient has a chronic painful condition, like sickle cell anemia or complex regional pain syndrome, and has acute pain from the surgery I performed that we hope will help them get off of opioids in the long run. It doesn’t matter if he had multiple rib and spinal fractures from a motor vehicle accident and, in my experience, will be in severe, acute pain for weeks. I can no longer write a prescription for more than seven days.

There is no question that overuse of opioids is a scourge on our society. Opioid-related deaths have increased steadily since the 1990s, largely because the danger of opioids had been underestimated and because a patient’s pain level has become a quality measure in medicine. Even when the dangers of opioids were recognized and physicians grew concerned about possible opioid misuse in our patients, the response of patients has often been to transition to cheaper, more readily available heroin and synthetic opioids like fentanyl that could be obtained by illegal means.

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Efforts by physician groups to curb the opioid epidemic are focused on preventing patients from becoming exposed to large quantities of opioids in the first place. Patients are encouraged to keep their medications secure so that others cannot obtain their medications and to dispose of them once they no longer need them. Physicians are encouraged to not prescribe opioids for chronic pain conditions if they are not leading to improved function.

However, many states, including Michigan, have rushed to legislate prescribing practices before the medical community knows what the best practices are. Congress is considering similar legislation with even greater restrictions.

We know that the vast majority of patients do not need even a week’s supply of opioids after gall bladder removal or carpal tunnel surgery, if they have not been chronic opioid users. However, we don’t know what a patient with pancreatitis will need, nor the patient after a spinal fusion or multisystem trauma. We also don’t know what the patient who has been on opioids for a year for their arthritis will need after a gall bladder removal.

So, what happens now that the new law has gone into effect? If the patient cannot reach me in a timely fashion, they are ensured a gap in their pain medications. This will lead to increased pain and an increased number of visits to the emergency room. People on chronic opioids who are being treated for acute pain will be at increased risk of going into withdrawal and may turn to illegal opioids if there is a gap in their treatment.

What are the solutions? To start, physicians, nurse practitioners and physician assistants should be required to have continuing education in pain management, including non-opioid based management, every year. We should also be required to provide a justification for prescribing more than a week’s supply of opioids for acute pain that will be reviewed by dispensing pharmacists. However, we should not be subject to legal limitations that are not based upon scientific evidence or real world practice.



Please do not tie my and my colleagues’ hands from using our best judgment to treat our patients. We have seen continued increases in opioid-related deaths, despite falling opioid prescriptions in the United States since 2013. We need to avoid any legal restrictions that will push our fellow Americans to illicit heroin and fentanyl.

Jason M. Schwalb, MD, FAANS, FACS is a practicing neurosurgeon in the Henry Ford Medical Group. He is the president of the Joint Section on Pain of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons and an associate director of the Michigan Spine Surgery Improvement Collaborative.​