Legislation Would Allow Partial Filling of Opioid Prescriptions

Sen. Shelley Moore Capito is one of four federal lawmakers to introduce legislation aimed at reducing the number of unused painkillers that end up on the street by giving patients and physicians more control over prescriptions.

The Reducing Unused Medications Act, which is now an amendment to the Comprehensive Addiction and Recovery Act, would allow pharmacists to partially fill prescriptions for opioid medications at the request of patients or physicians.

“In order to fight the drug epidemic and save lives, we must pursue solutions on all fronts,” Capito, R-W.Va., said in a statement about the legislation. “Allowing the partial filling of opioid prescriptions is one way we can reduce the drug supply and prevent unused prescriptions from ending up in the wrong hands.

“This bipartisan legislation will clarify federal policy, enable states to move forward with partial fill policies, and play a significant role in our broader effort to combat the drug crisis,” she said.

The Senate is still debating the Comprehensive Addiction and Recovery Act, which has been assigned to the Senate Judiciary Committee.

The Reducing Unused Medications Act was also sponsored by Sen. Elizabeth Warren, D-Mass., and Reps. Katherine Clark, D-Mass. and Steve Stivers, R-Ohio.

Currently, the Drug Enforcement Administration allows for the prescriptions of schedules III, IV and V to be partially filled with a request from the physician or patient, but the law is less clear and regulations are stricter for schedule II, including prescription opioids. The legislation would resolve ambiguity in the law about the regulations and allow states to have their own partial filling policies.

West Virginia law currently generally allows for the partial filling of schedule II medications if a pharmacist is unable to completely fill the prescription or the patient requests fewer than the number of pills prescribed. The remaining portion of the prescription may be filled within 72 hours of the partial filling as long as if the pharmacist cannot or did not fill the rest of the prescription within that time frame, they tell the prescribing practitioner.

According to the National Institute on Drug Abuse, more than 52 million Americans over age 12 have used prescription pills non-medically in their lifetimes. More than 70 percent of them get the drugs from friends or relatives, according to the Institute.

Dr. Carl “Rolly” Sullivan, a WVU Medicine addictions specialist, said he's in favor of the legislation.

“I think it looks like a good bill,” Sullivan said. “Fifteen years of the opioid epidemic that has been a scourge not only in West Virginia, but nationally, getting a handle on this is going to take lots of small but significant steps. I think this is a small but significant step that will help curb the misuse of opioids.”

Sullivan said the fact that the legislation is bipartisan proves the opioid epidemic is not a political issue. The United States consumes by far more opioids than any other country, he said.

“I think people get it,” he said. “Not just the legislators but people get that we have a problem with prescription opioids.”

Sullivan said 15 years ago, the legislation might have caused an outcry from physicians over a perceived transfer of power from doctors to patients. As it is, he thinks physicians will generally accept and support the legislation.

“There might be a very small minority that says this isn't a good idea, and they'll be drowned out by the wave of physicians who get it, too,” Sullivan said.

The amendment is also supported by the American Medical Association.

Dr. Kevin Yingling, dean of the Marshall University School of Pharmacy and a former chairman of MU medical school's department of internal medicine, said he also supports the amendment.

Yingling said there's an understanding that for the past 10 to 15 years, there have been too many controlled substances prescribed and left in patients' homes.

“Because of that there have been a tremendous number of medications that remain available for someone to divert or be abused,” Yingling said. “In fact it's very clear that many individuals who end up in addiction started because they started using medication from a family member or a friend.

“So I think there's certainly support for legislation such as that supported by [Senators] Warren and Capito in order to limit the number of controlled substances that remain available unused in a person's home and medicine cabinet.”

Yingling said while he supports the legislation, he also encourages state and federal legislators to more fully engage pharmacists' expertise in addressing opioid misuse and over prescribing.

“I would add that pharmacists clearly want to be part of the solution to address the unnecessary availability of unused medications,” he said. “I would encourage the senators and legislators to involve the pharmacists in this decision-making process so that they would have a choice in assisting the patient and the physicians in reducing the number of unused medications.”