Zed asked
I have been on Oxycontin 40mg x2 and Percocet 10/325mg x4 a day for almost 11 years for chronic pain and now my pharmacist said that he wants to talk to my Dr about cutting my dose in half. He said that a new law in New Jersey passed saying that a person with chronic pain can only be prescribed the equivalent of 100mg of morphine or less. Is this true? I have never asked for them early and never asked to raise my dose in the 11 years I've been on them. Please help. Should I find a new pharmacist? I live in New Jersey.
Answer
There must be some sort of confusion occurring in this instance regarding the communication between you and your pharmacist. There is no such law that we are aware of in New Jersey that states that all chronic pain patients are limited to a maximum of 100mg morphine (or equivalent) per day.
Just on the surface, it doesn't make sense as 100mg of morphine is a relatively low dose for a chronic pain patient who has been on opioid therapy for a long period of time. For comparison, the 80mg of oxycodone (from Oxycontin) you are taking per day is considered equivalent to 120mg of morphine, which would already be over this alleged threshold.
There was new legislation enacted in New Jersey in February of 2017 that limits initial prescriptions of opioid medications to no more than a 5 days supply. The new laws do not specify what a 5 days supply is and imposes no specific limit in terms of milligrams of morphine or equivalent.
The law is as follows:
"A practitioner shall not issue an initial prescription for an opioid drug which is a prescription drug as defined in section 2 of P.L.2003, c.280 (C.45:14-41) in a quantity exceeding a five-day supply for treatment of acute pain. Any prescription for acute pain pursuant to this subsection shall be for the lowest effective dose of immediate-release opioid drug."The law also discusses opioid use in "chronic pain patients":
The law does mention that "reasonable" efforts (unless clinically contraindicated) are to be made to stop or adjust the dose your opioid medication. However, this should be done in conjunction with your doctor. Be sure to talk to your doctor and pharmacist regarding the confusion in your case. If there has been new legislation, or something in the works, please let us know so we can look into this further for you."When a Schedule II controlled dangerous substance or any other prescription opioid drug is continuously prescribed for three months or more for chronic pain, the practitioner shall:
(1) review, at a minimum of every three months, the course of treatment, any new information about the etiology of the pain, and the patient's progress toward treatment objectives and document the results of that review;
(2) assess the patient prior to every renewal to determine whether the patient is experiencing problems associated with physical and psychological dependence and document the results of that assessment;
(3) periodically make reasonable efforts, unless clinically contraindicated, to either stop the use of the controlled substance, decrease the dosage, try other drugs or treatment modalities in an effort to reduce the potential for abuse or the development of physical or psychological dependence and document with specificity the efforts undertaken;
(4) review the Prescription Drug Monitoring information in accordance with section 8 of P.L.2015, c.74 (C. 45:1-46.1); and (5) monitor compliance with the pain management agreement and any recommendations that the patient seek a referral."
