In 2018, Governor Ducey signed the Arizona Opioid Epidemic Act, which set strict limits on opioid prescribing for physicians who practice in Arizona.[1] That legislation prohibited health care professionals from prescribing more than a five-day supply of opioids, with certain exceptions, e.g., patients with cancer pain, and patients in hospice. The legislation was the product of nationwide concern about opioid addiction and overdoses. Subsequent developments have led many to conclude that laws of this type were overly intrusive, and likely to cause unintended adverse consequences.
For example, a recent Perspective in the New England Journal of Medicine,[2] Inherited Patients Taking Opioids for Chronic Pain—Considerations for Primary Care, discussed the consequences of abrupt changes in prescribing practices, including increased risk of illicit opioid use, increased mental health crises and overdoses, and more frequent emergency department visits and hospitalizations. As a result, it appears that the regulatory pendulum is swinging away from hard-and-fast rules towards a recognition of the importance of allowing physicians to exercise good medical judgment.
In Arizona, physicians now have more discretion to prescribe opioids that exceed dosage limitations set in 2018. During its most recent legislative session, the Arizona Legislature approved Senate Bill 1162, which is effective on September 24, 2022.[3] The Bill amends an Arizona law that prohibits physicians from prescribing more than ninety “morphine milligram equivalents” unless the patient falls into certain exempted categories such as patients receiving hospice, palliative, or end-of-life care.[4]
Physicians may now exceed the ninety-milligram dosage limitation for patients who: (1) have “chronic intractable pain,” or (2) are “receiving opioid treatment for perioperative care following an inpatient surgical procedure.”[5] The new law defines chronic intractable pain as pain that is “excruciating, constant, incurable and of such severity that it dominates virtually every constant moment” and that also “produces mental and physical debilitation.”[6]
The opioid dosage limitation does not apply to patients with chronic intractable pain who have an established physician-patient relationship and have tried doses of less than ninety morphine milligram equivalents that have been ineffective.[7] The law does not change the requirement that, if a physician prescribes more than the ninety-milligram dosage, the physician must also prescribe naloxone or an FDA-approved equivalent to treat opioid-related overdoses.[8]
Physicians who prescribe opioids should update their policies and procedures to address the new law. If you have questions about the new law, or how it may affect your practice, please contact Milligan Lawless.
[1] Governor Ducey signed Senate Bill 1001 (2018) on January 26, 2018. The full text of SB 1001 is available here.
[2] Coffin, P and Barreveld, A, Inherited Patients Taking Opioids for Chronic Pain—Considerations for Primary Care, N. Engl. J. Med. 2022; 386:611-613.
[3] See A.R.S. § 32-3248.01. Governor Ducey signed SB 1162 (2022) on April 13, 2022. The full text of SB 1162 is available here.
[4] A.R.S. § 32-3248.01.
[5] Id. at (B)(4)(j)-(k).
[6] Id. at (G)(1).
[7] See A.R.S. § 32-3248.01(E). For purposes of the new law, an established health professional-patient relationship requires all of the following: (a) a patient has physically presented to a health professional with a medical complaint; (b) the health professional has taken a medical history of the patient; (c) the health professional has performed a physical examination of the patient; and, (d) some logical connection exists between the medical complaint, the medical history, the physical examination, and the drug prescribed. See A.R.S. § 32-3248.01(G)(2)(a)-(d).
[8] A.R.S. § 32-3248.01(D).
