California Leads the Effort to Reduce Opioid Prescribing

On November 9, 2017, California Governor Jerry Brown signed AB 1048 Healthcare: Pain Management and Schedule II Drug Prescriptions into law. The provisions of the law were very simple, shifting just two practices in the management of patients with pain. But while those shifts were simple, they were also incredibly significant.

Here were the two shifts:

• Since the mid-1990s, medical practitioners and establishments have been advised to make pain the “fifth vital sign” along with blood pressure, temperature, respiration, and heart rate. This was the beginning of a greatly increased emphasis on eliminating a patient’s pain which was the trigger for increased prescribing of opioids. In California, health facilities were required by law to assess pain along with the other vital signs. Now, they will be allowed to set their own policies on when and how to assess pain.

• A pharmacist will now be allowed to dispense a “partial fill” of a prescription—in other words, dispense a smaller number of pills—at the request of either the patient or the prescriber. Previously, if a prescriber ordered 90 tables of oxycodone, that was what the pharmacist had to give the patient. Now, a patient can ask for only a few day’s worth of pain relievers if he feels that is all he needs. And the pharmacist can legally comply with his request.

Why are These Modest Changes Significant?

Because it indicates that finally, the pendulum that began its swing toward profuse opioid overprescribing in the mid-1990s is finally starting to swing back toward a more balanced and unbiased system of prescribing.

In the mid-1990s, doctors and dentists began to be barraged with waves of propaganda in favor of lavish prescribing of opioid painkillers. A few authorities swore these drugs were not likely to be abused and were only rarely addictive. Pharmaceutical sales representatives courted doctors with dinners and other incentives to convince them to use these drugs to treat moderate pain—not just severe pain as was the previous philosophy.

Patient advocacy groups like the American Pain Society promoted the use of pain as the “fifth vital sign,” a practice that was written into law in some states. California passed their law requiring medical practitioners to assess all five vital signs at one time—effectively telling doctors how they should practice medicine.

Now, these two relatively modest changes mandated by AB 1048 indicate that the pressure is starting to come off prescribers so they are no longer being encouraged—overtly or covertly—to hand out as many opioid painkillers as possible.

Not an Instant Solution and Only One State

Since this is not a federal law, it only affects California practitioners. And it hardly means that all California doctors, dentists and nurses will immediately change their habits. But it is a step in the right direction. Followed by many more steps in the right direction, we can finally turn this opioid epidemic around and end the tragic loss of life from legal and illegal opioids.

The law takes effect on July 1, 2018. The author of this bill was Joaquin Arambula, an Assemblyman from the Central Valley.

To read the text of this law, click here.