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House Adds Exceptions for Opioid Limits

February 21, 2018 - 6:45pm

People with cancer or terminal illnesses and certain trauma patients would be exempted from opioid-prescription limits being considered by lawmakers, under a bill approved Wednesday by a House health-care panel.

Members of the House Health & Human Services Committee unanimously approved the bill (HB 21) after tagging on a 161-page amendment. Bill sponsor Jim Boyd, R-Bradenton, said he worked with the Senate and Gov. Rick Scott’s office for the past three weeks on the amendment.

The amended bill would limit to three days opioid prescriptions for patients suffering from “acute pain,” which is defined as the “normal, predicted, physiological, and time-limited response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute illness.”

Physicians could prescribe up to seven-day opioid supplies if they determine three days would be inadequate. They would be required to write “acute pain exception” on the prescriptions.

Unlike an earlier version of the bill, the latest iteration includes exemptions from the limits for cancer patients, people who are terminally ill and those who are receiving palliative care. Trauma patients who meet certain criteria for severity of injuries also would be exempt from the limits.

Despite the changes, the bill continued to face concerns from doctors.

Florida Orthopaedic Society lobbyist Toni Large said orthopedic surgeons are aware of opioid abuse problems but maintain that the proposed fix goes “a step too far.”

Large said the House proposal would exempt certain trauma patients from the restrictions but wouldn’t provide a similar exemption for people who undergo scheduled “major surgery.”

“My orthopedic surgeons want you all to understand that when you go back after this bill passes that you are going to have patients and loved ones and constituents that we are no longer going be able to effectively manage their pain,” Large told the House committee. “And we don’t want you to vote on this bill today without us getting that message across.”

She also warned that requiring patients to go back to surgeons after seven days to get additional prescriptions could make it more difficult to see orthopedic surgeons.

“It’s hard for many of you sitting here to get an appointment with your orthopedic surgeon today, it’s going to be twice as hard after this bill is passed,” she said.

While the bill passed unanimously, several members of the committee had concerns with parts of the amendment.

Rep. Gayle Harrell, R-Stuart, said she was worried about the lack of an exemption for patients who have undergone surgery. She told the committee that if her husband would have been required to revisit the surgeon seven days following a procedure, she “would have had to get an ambulance.”

With the annual legislative session slated to end March 9, lawmakers and Scott have been trying to reach agreement on a plan to help stem an opioid epidemic that has led to widespread overdoses. Legislative proposals largely focus on trying to prevent addiction to prescribed painkillers, which can lead to people taking street drugs such as heroin and fentanyl.

The House bill would require every physician registered with the U.S. Drug Enforcement Administration and authorized to prescribe controlled substances to take a two-hour continuing education course.

Rep. Cary Pigman, an Avon Park Republican who is a physician, said the requirement was so broad that it would impact the 44,000 physicians who are licensed in the state.

Pigman also noted that the bill was specific about which organizations could offer the continuing education requirements.

Boyd said that only the Florida Medical Association and the Florida Osteopathic Medical Association would qualify to offer the courses under the amendment. Pigman, who has been at odds with the Florida Medical Association in the past for his support of bills that would increase the scope of practice for nurses, asked about the fiscal impact on physicians who would have to take the class every other year.

Pigman, who has taken continuing education courses from the organizations in the past, suggested that the associations charge members $100 for such courses and non-members $200.

“What we are saying is (the associations) will get revenue of $4.4 million to $8.8 million every two years, which is probably why they support this bill. So when we vote for it with this piece in it, that’s what we are voting for,” Pigman said.

Boyd denied that any “deal’ was made with either of the associations.

“This whole process is give and take, and those are things we just kind of negotiate along the way,” Boyd said. “It’s something that made sense to us when we did it.”

Florida Medical Association General Counsel Jeff Scott called Pigman’s assertions “absurd.”

“We have significant concerns with the bill,” Scott said adding that the organization believes the Legislature should address the opioid “crisis” but has concerns with the limitations being imposed.

Moreover, Scott said, despite Boyd’s comments, other medical groups qualify to offer the course.

As for Pigman’s claims about upward of $8.8 million in revenues, Scott said, “Pigman can do math all day long. He has no idea what’s going to be charged. We don’t either. We just saw the amendment, so we haven’t contemplated that.”


I suffer with Chronic Recurrent Spinal Meningioma. My body produces tumors in the meninges which is the covering of the brain and spinal cord.The tumors grow in and around the nerve roots causing excruciating 24/7 pain. This is an extremely rare condition, in essence, a spinal cord injury. It will not kill me like cancer and there is, in my case, no cure. Surgeries (2) to remove the tumors were successful only temporarily because the growths have returned and multiplied. The most recent MRI showed them clustered up like grapes. They stopped counting at twenty. Four years ago I received an intrathecal pump which delivers a very small amount of an opioid medicine directly to the problem area. The pump was surgically implanted. This eliminates the need for medication in pill form and greatly reduces the overall amount needed to manage the pain. The pump is filled twice a year and programed by my pain manager. I am able to work and manage well most days. What Rick Scott has done will completely take away my quality of life. I will no longer be able to run my small business and will likely become a burden on the system. I will have to find a way to get rid of the pain as it is not bearable. I was ready to vote to send him to Washington. I will not do that now. What he has done reveals great arrogance and lack of judgement.

Thank you government, as of July 1 I'll officially be a criminal buying the pain meds I've been taking for 17 years from kids on the street. Worse yet is that sometimes I'm sure I'll have to resort to heroin (which I have never touched it needed to). I guarantee I'm certainly not above it if it gets me to work every day. Thank you elected officials for knowing so well what we need.

This is just the tip of the iceberg. Try going to the ER for ANYTHING... and let’s say you have a cardiologist, Neurologist and a GI DR. Well they just may not have privileges and the same hospital. Guess what ? You are a Drug / Dr shopper. I know this because it’s happened twice when I was sent to the ER by my primary care and that’s just what the ER DR. said and the Manager of ER Services backer him up. Fire two of your specialists of 15+ years so the ER Dr’s will treat you better. Fact DR”s and government are out of control and you just have zero rite to be sick. Makes you wish we were back to the days when you only got bad treatment if you were poor!!!

I do think something must be done, more treatment for addiction, mental health, treatment centers, policing. But wiping out painkillers for the truly chronically I'll who are in pain is ridiculous. Giving less to have a tooth extracted, yes, giving 3 days to someone needing surgery? What about women having C-section? Think they're gonna jump in a car and go back to Dr? I have Rheumatoid arthritis. My joints are slowly being eroded away by an ugly disease. I put off taking Vicodin for 10 years bc I didn't want to be addicted. I take the lowest amount possible. I am able to walk and not use walker, bathe myself, cook dinner (most days). What about MS pts?, Other pts? with nerve/disorders? Oh well, deal with it I guess. This kind of pain will result in more suicides bc pain can drive you crazy, changes who you are. Seems like heroin is the really big problem anyway since it's cheaper, easier to get, less risk in obtaining. Especially since the crackdown on pill Mills. God bless all the people who are really hurting, not getting high. BTW, bc of my metabolism changing, Marijuana speeds me, can't sleep, no relief at all.

A pain doctor can tell who is wanting to get high and who is killing pain. After all of this bull, why are legislaters after pain patents and their doctors? sure the pill mills created problems for the chronic pain patients but they eliminated that problem, now its getting herion and fentenly from major drug cartels. leave the pain doctors and clinics alone. go after the drug cartels and overseas suppliers please we have no problem cracking down on them. leave us alone to control our chronic pain! I am out of the wheelchair due to pain management helping me along with physical therapy. Stop the crusdes against pain doctors and clinics, I am out of the wheel chair due to their truly concerns to help me, Stop it, stop the cursaides against pain management doctors and clinics please?

A pain doctor can tell who is wanting to get high and who is killing pain. After all of this bull, why are legislaters after pain patents and their doctors? sure the pill mills created problems for the chronic pain patients but they eliminated that problem, now its getting herion and fentenly from major drug cartels. leave the pain doctors and clinics alone. go after the drug cartels and overseas suppliers please we have no problem cracking down on them. leave us alone to control our chronic pain! I am out of the wheelchair due to pain management helping me along with physical therapy. Stop the crusdes against pain doctors and clinics, I am out of the wheel chair due to their truly concerns to help me, Stop it, stop the cursaides against pain management doctors and clinics please?

Up until the beginning of 2017 (when I began to go into remission), I had been on high dose opiates for about 7 years to a max of 390mg of morphine per day. *** I have interstitial cystitis. (Prevention magazine did an article a few years ago in which they surveyed physicians re: the most painful illnesses, and the doctors ranked interstital cystitis as more painful than advanced cancer). I am one of the lucky ones. Not many people go into remission from this disease. My current dose is 30mg/day with an occasional 15-30mg additional dose. Opiate medications can be taken by those of us with chronic pain WITHOUT becoming addicted (physically dependent, yes--that's the nature of these kinds of medications. I *have* gone through withdrawals as I've weaned down.) Legislatures need to stop trying to intercede in the doctor/patient relationship. I believe the current crisis of overdoses is fueled by chronic pain patients who can no longer obtain legal prescriptions and have been driven to street drugs. Please let licensed physicians decide the appropriate dosages on a patient-by-patient basis, and keep the government out of the doctor-patient relationship.

I completely agree with leaving the doctors alone who deal with patients that are not chasing a high, but in fact trying to live a productive life while managing their pain. I myself am a chronic pain patient and have been taking opiate prescriptions for the last sixteen years of my life just to be able to do normal daily activities. The pain is never completely gone; instead the medications make the pain tolerable so I can have a quality of life without just wanting the Lord to take me and end my suffering. Do not misjudge what I just stated, I in no way whatsoever want to die, in fact it is the exact opposite. I want to live and enjoy my life, as I have been. I have a beautiful life and thank God every day I am here to experience every moment of my life. Unfortunately without my pain medications I will not be able to do so. I strongly believe that myself and others like me should not have to suffer for those that have abused the system. It just is not fair. I understand completely that there is a problem with people abusing opiates, and I am very happy the pill mills have been shut down. What does frighten me is the fact that street drugs that are hundreds times stronger are on the rise now more than ever, and are coming into our country at incredible speed; and these are also cheaper and getting easier and easier for our youth to access. This is where our government should be making stronger laws and closing off our borders, this is where our government should be focusing there efforts. I just pray that I don't have to suffer in horrific pain until a better alternative is put into action. Sincerely, A chronic pain patient who just wants to continue the quality of life I am accustomed to.

I agree what you just stated. I just wonder if, 60% of the Florida legislature and Gov.Scott, had injuries that required them to use hydrocodone daily just to reduce the pain by 75 percent, if they would have passed this legislation. We need to find out who is making the money off of this legislation.

I completely agree with you.

I agree 100%. I have Interstitial Cystitis as well only pi have never been in remission. This is a terrible excruciating disease. I m completely disabled and have zero quality of life without a legal pain medication. Let my dr practice medicine!!

It's not the liberals or conservatives it's all of them. They don't have a clue what chronic pain is and chronic pain doesn't grow from acute we must educate them. I say KNOWLEDGE IS POWER- send your letters into them each and everyone of them. My vision is giving birth the pain from it all day forever....... or if your male- getting kicked in the jewels with a four pound shoe and pain never goes away -now we're talking chronic pain. they have no idea they are only listening to the people from the side of addiction, criminals, and overdoses not real working or working on staying alive. Why should we be persecuted for having pain with our disease.. really us advocates are trying because it also affects us need you help. FLORIDA YOU GOT THIS ALL WRONG, now here the list of reps that did the vote --

This is just another pathetic attempt to make more deals so they can make more money! If you just had major surgery, you can Not just go to the drs in 3-7 days. These ***s have no idea what they are doing to the public they are Supposed to be working for! Instead, they are working for big pharma and medical facilities. People with chronic pain are the ones suffering here. MAT is Not much better either, it's only trading 1 addiction for (at the very least) a heavy chemical dependency! This is why the DEA is making mj, mmj, and kramtom Federally illegal while the FDA is fast tracking big pharma. Big pharma has already made the beneficial parts of those plants into pill form for m*** production. Our government agencies are Severely Crooked and Pathetic!

The members of the U.S. House of Representatives Health and Human Services Committee who unanimously approved H.B. 21 must be challenged on their actions. "VOTE THE BUMS OUT OF OFFICE" during the upcoming 2018 mid-term elections! The chronic pain patient and persecuted physicians who have been unjustly targeted by the government becuase of the hysteria of the "opioid crises" must stand up and be heard at the ballot box!

What about the millions of chronic pain sufferers who have been prescribed opioids for decades by licensed pain mgt. physicians? Remember the individual mandate that was just repealed effective 2018? ( US citizens were required by law to have health insurance and had to pay a penalty if they didn't). This is the same infringement on a persons right to choose their own physicians and healthcare plan. Spend some money on illegal drugs in Florida, esp. the pill mills. Ask the law enforcement guys who to go after. It will not be a 60 yr old grandpa on Oxycontin.

While I agree with about 99% of what you said, I have to disagree about labeling people that would or wouldn't be "the person who is part of the problem". There was a lady in her 70s , that was just arrested because she was selling much of her pain medication, for years. Tho, I agree that it's not the norm.

I'm sorry but in light of the fact that they are deploying every tactic they can to scare people into believing in the so called crisis, I wouldn't put it past them to either have it wrong or intentionally fabricate something to scare people further into supporting their agendas. There is a huge difference between addiction and medically dependant but they are trying to blur those lines at the expense of the CPP lives. Chronic pain patients need pain meds to live a partially normal life. They are not addicted therefore their pain is not a mental fabrication as a means to keep you taking it, that is the description of an addict. You can't just take away pain meds from a chronic pain patient and expect their pain to go away after a time. That's true for addicts, not ccp. CCP'S take pain meds because of chronic pain, something that never goes away. It's not a stubbed toe pain. It is mind altering pain, it changes everything about you and it is there till the day you die or they find a cure. So with all of this being said, you can't honestly believe that junkies won't get access to opiods you are sadly mistaken. It's like trying to abolish guns and expect criminals not to get access to them. These guidelines are not the answer!

I think if you are beung helped by pallative care and get your pain medication from a pain specialist , that shohld be okay, as in this area they dont have dr,s in pallative care.

Another stupid bill by know nothing lawmakers. We already have people dying from blackmarket opiates and Lawmakers want to drive thousands more to the blackmarket. Idiots

NO "EXCEPTIONS" ! ! ! "Let 'em "smoke pot"!.... (I think it was "Marie Antonette" who said that during the French Revolution); Well, we're in a "revolution" of our own, at the hands of liberal politicians and a complicit media. So,.. NO "EXCEPTIONS" ! ! !

Hope you face chronic pain and you get the same response.

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