Trump Administration to Limit Opioids for Federal Employees

On Monday, the Trump administration announced during a drug policy briefing it will limit opioid access to the 9 million government employees covered by the Federal Employee Health Benefits Program. The new restrictions follow other efforts nationwide to curb the opioid epidemic.

In a White House drug policy briefing, an anonymous senior official informed reporters the Trump administration would impose new rules on opioid prescribing for those enrolled in the Federal Employee Health Benefits Program. New rules will go into effect this fall. The Associated Press reported the restrictions will apply to opioid prescribing to reduce the risk of addiction for those given the medication after surgeries or for acute pain.

Patients will be given an initial seven-day opioid prescription, which can be refilled for three additional seven-day periods. A reauthorization beyond 28 days requires a check-in with a doctor. Previously, opioid prescriptions were initially given for 30 days. The senior official suggested new restrictions wouldn’t apply to “patients dealing with intractable pain from diseases such as cancer.” It’s unclear, however, what other conditions would fall under this category and what the opioid guidelines will be in those cases.

The Federal Employee Health Benefits Program is the largest job-based health care plan in the world according to the Associated Press. It covers 9 million government employees in the United States, including active and retired lawmakers, judges and their staff, military members, postal workers, and the families of those hired by the federal government.

The latest restrictions on opioid prescribing follow other efforts to curb the opioid epidemic nationwide. According to Pharmacy Times, Massachusetts passed the first state law restricting opioid prescriptions to seven days in 2016. More than half of states in the U.S. now have similar restrictions. Some states used more innovative scare tactics to reduce opioid prescribing rates, like California’s “Death Certificate Project,” which investigated prescribing doctors whose patients died after an opioid overdose.

The U.S. Centers for Disease Control and Prevention (CDC) provided prescribing guidelines for chronic pain patients in 2016 to reduce dependence on opioids. In 2018, President Donald Trump signed the SUPPORT for Patients and Communities Act, which puts additional pressure on doctors to limit or halt opioid prescribing, especially for those covered by Medicare and Medicaid. Some pharmacies started red-flagging and refusing to fill chronic pain patient’s opioid prescriptions.

Chronic pain patients, in particular, are negatively impacted by opioid restrictions. Chronic pain patients often see their opioid prescriptions suddenly discontinued, which can lead to additional chronic pain and withdrawal symptoms. In 2018, the CDC indicated many prescribers poorly implemented the CDC’s opioid guidelines and harmed chronic pain patients.

“Like many pain patients, I initially resisted taking opioids. I exhausted every other possible treatment first,” wrote Mighty contributor Kate Nicholson, adding:

Treatment with opioids and integrative care allowed me to maintain a job, a sense of purpose and community until I found my way to healing. Mine is a story rarely told of someone who took opioid analgesics for years and went off them without incident when the pain remitted. Given the environment today, such stories may well become extinct.

Preliminary data from the CDC suggests the rate of overdose deaths due to opioids slightly decreased in 2018, down from about 49,000 deaths in 2017 to an estimated 47,600 in 2018. While opioid prescribing rates also decreased since 2016, the latest CDC data shows that fentanyl overdoses continued to rise. Fentanyl is most often found in illegal street drugs and is the biggest contributor to opioid-related overdoses. Fentanyl caused 32,000 deaths in 2018.