Physicians, not pharmacies, should control opioid prescriptions

May 30, 2018

Physicians are used to fighting for the right treatment for their patients.

Physicians are used to fighting for the right treatment for their patients.

From requesting prior authorizations to preparing patients for what they will pay at a pharmacy, the physician has to defer to a third party. Now the battle over treatment has a new obstacle: pharmacy restrictions on opioids.

Following on the heels of CVS last year, Walmart announced that this summer, its eponymous stores and Sam’s Club locations will restrict initial acute opioid prescriptions to no more than a seven-day supply, with a cap on potency per day. This policy, like the one from CVS, aligns with the CDC’s guidelines for opioid use.

Walmart says the new policy is a direct action against the nation’s opioid epidemic to curb abuse. The company did not respond to a Medical Economics’ request to discuss the policy.

Many physicians agree there is no single solution to stem opioid abuse and the solution lies in various initiatives from all stakeholders.
But the same cohort would also say that pharmacies setting mandatory limits on opioids with no room for physicians to advocate on behalf of their patients is an overstep. Furthermore, it puts a strain on the already stressed physician-patient relationship when yet another third-party puts up a barrier on the road to wellness.

Add to that the issue of patient access to the opioids some need to quell their pain. Requiring multiple trips to a pharmacy puts up another barrier for those who might have transportation issues as well as the possibility of multiple co-pays per refill.

Here’s something doctors know well: Pain is not the same among patients and technology has yet to design an instrument to truly indicate its severity in the human body.

So setting a stringent limit for all patients and all physicians is not just an overreach, it’s a huge misstep.

I support moves to keep unneeded opioids off the street and safely locked away in a pharmacy. I think being cautious with prescribing is also a good idea-again, not every patient in pain will need the same amount or duration of opioids. And this clearly looks good for Walmart taking such an aggressive stand and being “part of the solution.”

To tell physicians that a pharmacy knows better regarding a patient they have never treated, let alone likely even seen in person, is simply not good policy. The last thing physicians need are additional blanket policies to negate their years of insight and expertise.

Walmart-and its peers-need to be a part of lending a hand to solve the opioid crisis. But not by turning their backs to physicians.

Keith L. Martin is editorial director of Medical Economics. Do you think putting non-negotiable limits on opioid prescriptions is a good idea? Tell us at medec@ubm.com.

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