States look to directives to allow patients to refuse opioids

A number of states are considering laws to allow a non-opioid directive be placed in patients' medical records.

A number of states are considering legislation to allow patients to put a "nonopioid directive" into their medical record so they will not be prescribed opioid painkillers.

The action is being taken because of the fear that exposure to opioids can lead to a relapse into addiction, according to the Associated Press.

Two states—Massachusetts and Pennsylvania—passed laws last year that allow patients to put a directive in their medical record making it clear to medical professionals not to prescribe or administer opioid medications. Connecticut and Alaska are among states now considering similar legislation, the AP said.

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But some worry such directives could prevent a patient from receiving needed pain medication, for instance, after surgery. Seth Mnookin, an assistant professor at the Massachusetts Institute of Technology who kicked a three-year heroin addiction, said states should require patients with substance abuse histories to see an addiction specialist after receiving pain medication to prevent a possible relapse.

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Meanwhile, a new study, reported in the Morbidity and Mortality Weekly Report, showed how quickly the risk for long-term opioid use occurs. For patients who need an initial opioid prescription, supplying three or fewer days' worth of medication reduces the likelihood of long-term opioid use, the data showed.

For patients who received a first prescription for opioid pain relievers, the likelihood of long-term opioid use increased with each additional day of medication supplied, starting with the third day, the study found. One medical center has created guidelines that suggest surgeons limit prescriptions of opioid painkillers to a specific number based on the type of surgery a patient undergoes.