Expert questions Ohio opioid prescription limits

Local News

DAYTON, Ohio (WDTN) – Dr. Richard Lawhern began advocating for chronic pain patients 22 years ago.

Lawhern, who graduated from UCLA with a doctorate in engineering systems, began working with chronic pain sufferers due to his wife’s battle with facial pain. His step-daughter has battled Parkinson’s disease.

Lawhern isn’t professionally trained in medicine, but he’s talked to tens of thousands through online communities he’s organized and moderated, articles he’s posted and social media. When he hears states are planning limits on pain medication, he becomes concerned.

“Every time the government gets involved in limiting medicine, you can bet the bottom dollar they’ll get it wrong,” Lawhern said.

Lawhern became concerned when Ohio Senator Rob Portman proposed in a 2 NEWS interview limiting opioid prescriptions to three days.

“Do you want someone who has had a hip replacement coming back to the doctor after three days to get a new prescription?” Lawhern said. “Moving is pure agony. Do you want to have a patient who is prescribed opioids for a condition like complex regional pain disorder, a horrendously painful disorder, to come back for a renewal every seven days? I don’t think so. These people have mobility issues, they sometimes live in rural districts and they are hundreds of mile from the site of treatment.”

Ohio’s current law limits most opioid prescriptions to seven days for adults, and five for children unless pain is acute.

“The limits apply differently to acute pain,” Ohio State Medical Board communications director Tess Pollock said. “If it’s longterm pain, if it’s chronic pain, it applies differently.”

Lawhern said the limits send a message to doctors that they should be wary of prescribing opioids. While the issues involving medicine, prescriptions, and addiction are always nuanced and never easy to group, the rules could have the effect of making physicians wary.

“It’s a subtle point, but one I think is valid,” Lawhern said. “The imposition of such limits, it puts doctors on notice. Any decision they make regarding opioids will put them in danger of their practice. With this kind of regulatory environment, they may not risk making a prescription.”

Pain management and addiction

Lawhern has challenged the orthodoxy on opioids in areas such as Stat News and NationalPainReport.com. He’s also helped run an online forum and community for people dealing with chronic pain.

Lawhern said underprescribing patients pain medication could be more of a problem in causing addiction.

“We know the minimum dose in controlling pain can vary in individuals, ” Lawhern said. “Opioids have to be metabolized and broken down by the liver and the body to be effective. Some are effective, some are average and there are some who break down at a horrendous rate, these people are hyper metabolizers. These people are often ignored.”

Lawhern said the typical patient for chronic pain is female and in her 40s. The typical opioid addict is male and young.

“If her life is stable enough where she can see a physician regularly, (the typical patient) is almost never an addict,” Lawhern said.

Impact of rules in Ohio

Pollock said since Ohio passed its seven-day limit in 2017, there has been a substantial reduction in deaths related to opioid pills.

She said one of the goals of the rules was to keep pills from being diverted from the patient. The state also took care of weighing different factors. In Ohio, she said the process isn’t a quick step.

“The state, the new rules, we took public comment through several different rounds,” Pollock said. “We talked to experts across the state and we also looked around the country. It was very much scientifically based.”

Pollock said as a regulatory board, they focused on how the changes impacted patient care, physicians and physicians assistants.

“Ohio has a fairly extensive rulemaking process,” Pollock said. “We have to go through several areas of public comments, we hear from different folks of different parties and professions.”

Lawhern is concerned about adding anything between the patient and doctor relationship.

“We know the minimum doses in controlling pain can vary in individuals,” Lawhern said. “The numbers, the medical evidence doesn’t support the policy.”

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