States Seek Hospice Exemption for Opioid Prescription

A year after imposing restrictions on opioid prescriptions, some states now seek to loosen the reins. Florida is the most recent state to consider exempting hospices from restrictions designed to curb the nation’s opioid epidemic.

A state Senate committee on Feb. 19 approved a bill that would exempt health care providers from checking the state’s opioid database before prescribing those medications to hospice patients.

The bill is intended to address concerns that the database checks delay necessary pain management for patients at the end-of-life. Florida instituted the database requirement in legislation passed last year.

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“These patients were not out there doctor shopping. They were not out there looking for opioids in the streets. They were mainly bedbound and in pain, short of breath, being managed by hospice providers.” Stephen Leedy, M.D., a Florida Hospice and Palliative Care Association board member told the Florida Senate Health Policy Committee in a recent hearing.

Curbing opioid abuse has become a legislative priority on the national and state levels. More than 218,000 people in the United States died of prescription opioid overdoses between 1999 and 2017, according to the US Centers for Disease Control and Prevention (CDC). Nearly 70 percent of all US drug overdose deaths during 2017 involved opioids, including both prescription and illicit drugs such as heroine, CDC reported.

Legislatures in 45 states considered more than 480 bills in 2018 related to opioid misuse and overdose, according to the National Council of State Legislatures (NCSL). This number does not include bills outlining addiction treatment, criminal justice, or child welfare issues related to opioids.

The number of states placing limits on days of opioid supply or dosage rose from eight to 33 between 2016 and 2018, NCSL reported. Most states exempt hospice and palliative care prescribers from these limits, as do the CDC Guidelines for Prescribing Opioids for Chronic Pain. However, other requirements, such as Florida’s database checks, can create delays.

“While these limits are appropriate and advisable for acute and chronic pain, they may hamper the ability of hospice and palliative care practitioners to provide timely access to pain relieving medications for terminally ill individuals,” the National Association for Home Care and Hospice

said in a position statement.