March 30, 2020 1:32PM

Health Canada Sets A Good Example By Relaxing Opioid Prescribing Rules During COVID-19 Pandemic

By Jeffrey A. Singer

Federal and state regulations are being waived or relaxed so that patients can receive medical care and continue their medications while social distancing or quarantining during the COVID-19 pandemic.

For example, states are relaxing licensing requirements and scope of practice laws in order to allow more health care providers to serve people in need. The Centers for Medicare and Medicaid Services has taken steps to promote the practice of medicine, including telemedicine across state lines. The Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration have made it easier for people receiving Medication Assisted Treatment for drug addiction to continue on methadone or buprenorphine while practicing social distancing.

Sadly, both acute and chronic pain patients on opioid therapy still must contend with onerous requirements, such as limits on the number of pills per prescription and the requirement to be seen by the prescriber in order to obtain a refill. Some of these requirements are state‐​based. Some are federally imposed, including last year’s rule from the Centers for Medicare and Medicaid Services that Medicare Part D beneficiaries with acute pain be given no more than a 7‐​day supply of prescription opioids as initial treatment for their pain. With patients confined to their homes—many already relatively immobilized by their pain—these regulations become an even greater burden.

Health Canada, the regulatory agency that oversees Canada’s health care system, recognizes this and has urged its provinces to:

  • permit pharmacists to extend prescriptions;
  • permit pharmacists to transfer prescriptions to other pharmacists;
  • permit prescribers to issue verbal orders (i.e., over the phone) to extend or refill a prescription; and
  • permit pharmacy employees to deliver prescriptions of controlled substances to patient’s homes or other locations where they may be (i.e self isolating).

In response to the current public health emergency, the DEA, SAMHSA, and CMS should follow the example of Health Canada and waive prescription limitations, as well as requirements for in‐​person evaluation for refills, and encourage states to do the same. Governors should then issue executive orders waiving state‐​based restrictions. As regulations are relaxed or waived to address the needs of patients while we are all being asked to engage in social distancing and self‐​quarantine, pain relief must not be given short shrift.