Virginia’s New Restrictions on Opioid Painkillers | Shapiro, Washburn & Sharp

After declaring prescription painkiller addiction a public health crisis in late 2016, the Virginia Board of Medicine and Gov. Terry McAuliffe in February 2017 issued new strict regulations for prescribing and dispensing opioid medications.

Opioids, which are chemically similar to the opium that gets processed into heroin, come in numerous branded and generic forms. Some of the most commonly used are OxyContin (sustained-released oxycodone), Vicodin (hydrocodone and acetaminophen) and fentanyl, Misuse and abuse of that last drug product, originally intended for use by people with extreme pain due to late-stage cancer, has become particularly problematic because it is 1,000 more powerful than most other opioids.



Opioids More Fatal Than Car Crashes

Virginia health officials issued the following alarming assessment of the opioid crisis on Nov. 21, 2016:


By the end of 2016, the numbers of fatal opioid overdose deaths are expected to increase by 77 percent, compared to five years ago. In 2014, for the first time in Virginia, more people died from opioid overdoses than fatal car accidents. Emergency department visits for heroin overdose for January-September 2016 increased 89 percent, compared to the same nine-month period in 2015. In the first half of 2016, the total number of fatal drug overdoses in Virginia increased 35 percent, when compared to the same time period in 2015, and in 2013, fatal drug overdoses became the number one cause of unnatural death [emphasis added].




The spike in deaths from prescription painkillers stems from multiple factors, one the most significant of which is the addictive nature of the medications. The Drug Enforcement Administration places most of the drugs in this class in Schedule II. That designation indicates that while opioids have legitimate therapeutic uses, they also pose serious dangers when taken in large doses, for long periods or by people who are already taking similar medications.

Once a person develops an addiction to opioids, he or she requires increasingly higher doses to produce the desired effect. Stopping opioids suddenly brings back the original pain — often in far worse intensity — along with withdrawal symptoms best described as horrific.

When he signed off on the changes to how opioids will be provided to patients on Feb. 20, 2017, Governor McAuliffe said, “Abuse of opioids continues to kill Virginians. … We recognize that addiction is a disease, not a moral failing, and our proposals for this General Assembly session focused on preventing addiction and providing treatment for those who suffer from it.”

Alternatives for Pain Treatment and Addiction Treatment

The Medical Society of Virginia has posted summaries of the state’s updated opioid prescribing and dispensing requirements online. A significant improvement comes in the form of clarifying when and how to get individuals involved with buprenorphine therapy. Buprenorphine has been shown to help people break the opioid addiction cycle, but maximizing positive results requires close monitoring.

Regarding opioids, doctors and pharmacists must now

  • Complete and document a full pain assessment and patient history
  • Consider alternative to medications
  • Consult the Prescription Monitoring Program database to flag individuals who go to multiple health care providers in rapid succession to acquire opioids
  • Limit doses of opioids to the smallest number needed to address the patient’s problem
  • Dispense naloxone (Narcan) with each opioid prescription so an overdose can be quickly reversed
  • Issue written treatment plans that patients must follow or lose their ability to get refills
  • Counsel every patient on risks, benefits and alternatives to opioids

Medical Board Guidelines and Requirements Create Legal Obligations

The new rules for prescribing and dispensing opioids in Virginia protect patients in multiple ways. One of the more important ways they do so involves establishing a set of best practices for pain treatment.

When health care providers ignore best practices, they open themselves to accusations of medical malpractice. Since opioids are so well-recognized as dangerous drugs, they must be used in the best ways possible to minimize potential harms. The updated guidance from Virginia’s medical board establish a baseline for best practice that families who lose loved ones to unintentional opioid overdoses can reference if they decide to work with a Virginia dangerous drug attorney to try to hold a negligent doctor or pharmacist accountable.