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Walmart's 7-Day Opioid Prescription Limit Is Medically Unsound and Could Backfire

Like state legislators, the chain is taking its cue from the CDC's guidelines.

WalmartWalmartThis week Walmart announced that its pharmacies will refuse to fill initial opioid prescriptions for acute pain that last longer than a week. That policy, aimed at preventing opioid abuse, will impose a burden on patients who need relief for more than seven days and could backfire by increasing refills, meaning more unused pills will be available for diversion.

Walmart says the seven-day limit is "in alignment with" the opioid prescribing guidelines issued by the U.S. Centers for Disease Control and Prevention in 2016. According to the CDC, "three days or less will often be sufficient" for acute pain, while "more than seven days will rarely be needed." Apparently taking their cue from the CDC, legislators in 18 states have limited the length of initial opioid prescriptions for acute pain since the guidelines were published, according to a tally by the National Conference of State Legislatures (NCSL). Seven days is the most common limit, although some states allow only three, four, or five days. Legislators in another nine states have authorized regulators to impose prescription limits.

The problem, as a study reported in JAMA Surgery last January pointed out, is that some patients need more than seven days of pain medication. That means they are apt to seek refills but may end up using only part of the second prescription, leaving more rather than fewer pain pills in circulation.

Harvard surgeon Rebecca Scully and her collaborators looked at prescription data for more than 200,000 patients who took pain medication after surgery, 19 percent of whom received at least one refill. The prescription length associated with the lowest probability of a refill was nine days for general surgery, 13 days for women's health procedures, and 15 days for musculoskeletal procedures. "In practice," Scully et al. conclude, "the optimal length of opioid prescriptions lies between the observed median prescription length and the early nadir," i.e., the point where a refill was least likely.

That rule of thumb would put the optimal prescription length between four and nine days for general surgery, between four and 13 days for women's health procedures, and between six and 15 days for musculoskeletal procedures. "Although 7 days appears to be more than adequate for many patients undergoing common general surgery and gynecologic procedures," Scully et al. write, "prescription lengths likely should be extended to 10 days, particularly after common neurosurgical and musculoskeletal procedures, recognizing that as many as 40% of patients may still require 1 refill at a 7-day limit."

According to the NCSL's summary, some states with prescription limits make exceptions for postsurgical pain, but most do not. Neither does the policy described by Walmart, which will apply even in states that allow longer prescriptions. When the evidence suggests that a 10-day prescription of pain medication is more appropriate for certain categories of patients than a seven-day prescription, an arbitrary and indiscriminate one-week rule is clearly not conducive to good medical practice, and it may not even achieve the avowed goal of reducing nonmedical use of narcotic analgesics.

More generally, the continued focus on restricting access to pain pills makes little sense in response to an "opioid crisis" that mostly involves illegally produced drugs. In fact, to the extent that such restrictions work as intended, they will drive more nonmedical users toward deadlier black-market substitutes, fueling the upward trend in fatalities involving heroin and illicit fentanyl.

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  • loveconstitution1789||

    If I had a prescription with Walmart, I would let the manager know exactly why I pulling my prescriptions from their pharmacy.

    I don't want companies butting into medical business between me and my doctor.

    I would also consider suing Walmart for HIPPA violations because Walmart is violating the security provision of HIPPA that prevents even legitimate users of PHI from releasing more than "minimum necessary". Walmart has no need to know what people are taking besides what kind and quantity to order.

    Hammer any company under HIPPA until they drown in regulatory legal action.

  • Longtobefree||

    Sadly, that idea requires the federal government to take action that is opposed by the progressive bureaucrats. HIPPA means only what the feds determine it means.

  • Ron||

    most pharmacist are probably against this rule. since they actually do know what they are for.

  • loveconstitution1789||

    Maybe. Some of the pharmacists that I come across are so brainwashed by government rules, they look at customers like we are all drug addicts waiting to happen.

  • Ron||

    I've tested a few pharmacist due to my medical condition and they've all been pretty responsive but that is anecdotal. a sample of maybe three. but its something i do whenever I get a new pharmacist if they answer wrong I go somewhere else

  • Zeb||

    They're probably also terrified by government rules.

  • Hackmaschine Mutter||

    You completely misunderstand HIPAA. Besides, any business has the right to set the terms of their services. So STFU and take your scripts somewhere else.

  • loveconstitution1789||

    STFU and don't explain yourself.

    Duh, my name is mutter, and I am dumb as butter.

  • Hackmaschine Mutter||

    My name is mother, and your name is STFU Motherfucker.
    Protected Health Information includes individually identifiable information in any form, including information that is transmitted ORALLY, or in written or electronic form. This Privacy Ruling requires that covered health care entities make REASONABLE efforts to limit the use or disclosure of protected health information to the minimum necessary.

  • ThomasD||

    "I would also consider suing Walmart for HIPPA violations because Walmart is violating the security provision of HIPPA that prevents even legitimate users of PHI from releasing more than "minimum necessary". Walmart has no need to know what people are taking besides what kind and quantity to order."

    You'd lose. Because your understanding of both HIPPA, and the practice of pharmacy, are both woefully inadequate.

    Like it or not any pharmacy handling controlled substances is licensed by the DEA. I'm all for getting rid of this requirement, but until that happens the pharmacist is legally and professionally bound by these terms.

    https://tinyurl.com/y8dk5kna

  • UnrepentantCurmudgeon||

    Good point, but it's HIPAA (Health Insurance Portability and Accountability Act)

  • Longtobefree||

    So only those having surgery need pain medication? I would have thought they would focus on the actual issue, long term pain management. But that would require looking a all forms of pain management, including substances currently listed as schedule one, but with documented medical uses. In other words, the DOJ would have to follow the law; we can't have that.

    Here is a really crazy idea; let the doctors treat each patient individually. It is possible that a single dosage limit may not be what is best for every patient in the state. Democrat fantasies not withstanding, people are individuals, and vary in their response to medications.

  • Zeb||

    The dosage limits are especially stupid. People have widely varying sensitivity to opioids. I have a close friend who has never used opioids recreationally or anything, but after a shoulder surgery discovered that he has a naturally very high tolerance. They gave him vicodin for the pain and to get them to actually work he had to take way more APAP than is healthy. People need the dose they need.

  • Ron||

    the size of a person is also a large determiner in dosage and it pisses me off when some tells a person in pain to exercise to lose weight. pretty damn hard to exercise while in pain if at all. I'm not overweight but I'm a gout sufferer not only can you barely exercise my Doctor says exercise will release more Uric acid causing more gout. It a loose lose situation and the governments policy of one shoe size fits all is always wrong.

    BTW i don't use opiods my pain is not to that level yet

  • Hackmaschine Mutter||

    Long term users of opioids plateau in the effectiveness & need ever increasing doses; this is not due to a worsening of their medical condition.

  • Sedona Vortex Hunter||

    this is not true. My wife was a Pharm D and MD, she also had cancer on and off from 1994 until 2014 and took pain meds over that entire period and while her dosage requirements did increase (partly in response to metastasis and numerous surgeries), it reached a point around 2007 where it never increased despite continued metastasis and eventually death.

    The dose she was stable upon was large compared to an opiate naive individual, but it did eventually stabilize. The drugs allowed her to have the best life she could have hoped for given her circumstances. She died young (still in her 30's), but was able to graduate college, pharmacy and then medical school while also taking pain medications and having numerous surgeries and procedures.

    I can't imagine her life if she had not had access to the pain medication she took. I don't know what her life would have been like if she had been attempting to make her way through school and life in today's climate. It is lucky that by the time the opiate panic began to take root she was already an established professional and knew how to work with in the system. Her life would have been much, much worse had she been constantly harassed and forced to negotiate a long, complicated, never ending bureaucratic and medical gauntlet every couple of weeks to get her medicine.

  • Diane Reynolds (Paul.)||

    These are common-sense opioid control measures.

  • Number 2||

    Are they banning assault opiods?

  • ThomasD||

    Wal-Mart is not saying you can't have them. They are just telling you you cannot get them here.

    This is a big bucks decision on their part. It will cost them a lot of business. I suspect they did the math and decided this approach was cheaper than dealing with all the legal, regulatory and liability hassles.

    The liability hassles are coming, and they are going to be gigantic. Anyone with deep pockets has to be thinking of ways to protect themselves.

  • DajjaI||

    It's actually scary because people worry it won't be enough to get through the pain. And this results in unintentional 'drug seeking' behavior. So yes this could backfire, but in a good way, as normal people resent being lumped in with the addicts and thus demand a return to sanity. Even better is to infiltrate your local 12 Step group and hear the stories from the malcontents and losers for whose sins you are suffering. "I 'borrowed' half a pill from my uncle who just had shoulder surgery and I got hooked immediately." There's no winning with these people.

  • loveconstitution1789||

    This is another reason why required prescriptions need to be abolished.

    We are clearly not concerned about doctors treating patients in the best way for the patients.

    MOAR WAR ON DRUGS!

  • Ron||

    thats truely all this is isn't it, damned be the patient you get to suffer while the habbitual user will get his through the black market anyway

  • ThomasD||

    I agree entirely. We are in this problem because back in the twentieth century government decided it needed to step in and save people from themselves. This is the same song, but a different verse.

    The problem is how to unravel payment - so much of what insurance/medicare/medicaid does in terms of coverage decisions is piggybacked onto the professional functions of prescribers and dispensers - from the rest. Until that ball of yarn is untangled there will be no real changes in the laws restricting access to drugs.

  • Sedona Vortex Hunter||

    yeah, this is why I don't hold out much hope.

    MD's may not like to admit this, but if people suddenly could get drugs without a script doctors would lose a lot of patient visits and money. Not to mention pharmacists who today earn very good money and have gone to school for 8 years and have loans justified as being worth it based upon the current pharmacist salary.

    This is just off the top of my head. Then you have police, DEA, law makers, border agents, lawyers, prisons, prison guards, bail bonds, bounty hunters, drug dealers...not to mention the CIA/black ops 'conspiracy theories' surrounding this issue..

    How much of our society earns a living based on the illegality of and/or regulation of what individuals put into or do with their body?

    Seems impossible to unravel from this point, too many make huge amount of money based on the idea governments have the right (even moral obligation) to enforce what does or does not go into an ones body.

  • Jerryskids||

    Sad to see Walmart making this sort of mistake, you'd think they know their customer base better than that.

    Reminds me of years back when I stopped at a little country store out in Bumfuck, Alabama and it took me a minute to figure out why the hell they'd have a half pallet of 25-pound bags of sugar sitting right up there by the cash register at this little convenience store out in the middle of nowhere.

  • Ron||

    its comparable to Dicks sporting goods stop selling "Assault Rifles" its all virtue signaling

  • ThomasD||

    No, Wal Mart sells guns too.

    This is about the regulatory hassles of handling controlled substances, the legal liabilities to the various governments and agencies, the liabilities of and to customers, and the blasted expense of it all weighed against the revenue generated.

    All the various forces are tipping towards limiting your exposure whenever possible..

  • MSimon||

    This, when passed, should be the start of a fix.

    Addiction is a medical problem - Trump

  • Eidde||

    Is this Wal-Mart's fault, or are they rationally worried about being indicted if they're not "tough" enough?

  • jdgalt1||

    I've started a petition on change.org to Walmart urging them to abandon this stupid new policy. Please sign it.

  • ThomasD||

    Better to spend your time finding a pharmacy willing to treat you like the individual you are.

    Might cost you a bit more though.

  • Finrod||

    Because someone in severe pain has no problem just running out to a store every few days to get what they need to keep living.

    It wouldn't be the first wish I made, but it'd be one of the three: that every legislator and every lobbyist that has voted for or advocated for restrictions on opioids and other painkillers be stricken with permanent severe chronic pain and be unable to get any medicine to relieve it in any way whatsoever because of the laws they themselves voted for or advocated.

  • Ron||

    You know legislators aren't held to the same laws they make Just like their own house bank that ignores their overdrafts they probably have a house pharmacist who has no limits to the medication they dispense

  • Jerryskids||

    Didn't this come up in the discussion over making the White House doc the head of the VA, that he routinely handed out sleeping pills and pep pills to reporters and aides on overseas flights to help them deal with the jet lag? And everybody said it's no biggie, they've always done it and these people really do need the pills to do their jobs.

    My niece is an emergency OR nurse where she's frequently called in during the night even if she's already worked a full shift. She has to grab a Coke on the way out the door to get perked up because the hospital doesn't hand out pep pills for nurses that need them to do their jobs. I'm sure that's just the hospital being stingy and not that it's their ass if the inventory logs for the dispensary don't add up and it's one set of rules for the sheep and a different set for the hogs.

  • JudoPete||

    Fine by me. If the Walmart pharmacy won't fill my pain management prescriptions as written by my doctor they won't get the rest of my business either. I have a complex medical history and require a lot of medication. I'm sure another pharmacy will be more than happy to take my business.

  • JeremyR||

    The problem is that more and more pharmacies will follow Walmart's lead. And the ones that don't will no doubt be under close government watch.

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