Lets Close the Loophole
My son and I have written our congressional representative about limiting the refills of high dose opioids. If you agree, please help and write your representatives about a change in the law to close the opioid prescribing loophole and help keep our families safe. A draft of the Doctor Sevarg and Son letter is appended to this web page for you to “cut and paste” into your own letter.
Legislator Name
Legislator Address 1
Legislator Address 2
Month Day, 2022
Dear Legislator,
I am writing to you to ask you to consider sponsoring a bill that would change the opioid law
and limit the individual daily amount of opioids that can be “refilled” to 50 MME’s. (This limit
represents 300 of the Hydrocodone 5-325 pills per month) This change in the law will reduce
but not eliminate the extra opioids in the family medicine cabinet. Practically, these 2
sentences have been have written as an addition to the law will not be significantly
burdensome to the average opioid prescribing physician practice. It is my opinion that they be
a hinderance to “pill mill” practices and it will also reduce the number of opioid pills in the
family medicine cabinet.
​
Most of us are both heartened and worried about the recent Supreme Court ruling from
6/27/2022. This ruling has put patient care back in the hands of doctors without any second-
guessing by administrators reviewing the cases. Practicing physicians, feel very strongly that
the practice of medicine belongs in the hands of physicians. Most everyone is pleased that the
Supreme Court recognized that patient care is a “one patient - one doctor - one problem” at a
time medical practice. This recent decision that removed the 4 th branch of government from
oversight also left an oversight void for opioid prescriptions. The current federal law puts
individual physicians in charge of their own practice oversight. There is no longer any
secondary governmental oversight. Most everyone would all prefer that the law reflect and
clearly define the expectation of medical practice to be along the line of academic and thought
leaders in medicine rather than leave all opioid decisions to individual practitioners and
doctor’s individual conscience.
​
Our society is dealing with three concurrent opioid problems, 1) new exposures to opioids that
result in increasing the number of addicted people, 2) deliberate fentanyl contamination of
drugs resulting in overdose and death, 3) opioid addicted people who want to quit and need
help to do so. This opioid crisis is a composite of all three of these issues. Thousands of people are losing
their lives due to this opioid crisis. We cannot afford to be complacent. It is my opinion that
the government can do a lot of good with a simple change in the opioid law. Please help
reduce this opioid problem.
We propose a minor legislative addition to the opioid prescription law. We propose limiting the
access to multiple prescriptions be limited to only patients using less than 50 MME of opioids.
Our proposed amendment to the law will continue the current practice of opioid refills for
patients on low to moderate dose opioids. Patients on higher dose opioids should be seen by
their doctor for the refills of their opioid medication. These patients are very ill and are at high
risk of accidental overdose. Frequent contact with patients who are using high dose opioids is
good medical practice and it is endorsed by all the medical societies.
​
Our proposed addition to the law will not affect patients receiving Schedule II Attention Deficit
Disorder (ADHD) medications such as Adderall. The MME associated with these medications is
zero. Patients can continue to get their “refills” (multiple prescriptions) as they are accustomed
to and without any change in practice patterns.
​
In summary, we agree with a proposed legislative change will reduce the opioids in the family
medicine cabinet, and it will reduce the “pill mill” opioid availability. The legislative change that
is proposed will not have any significant impact on the provision of opioids for patients with
moderate pain. The proposed addition to the law will not affect patients receiving ADD
medication. They can continue to get their refills as they are accustomed to and without any
change
SUMMARY: Proposed Legislative Change (multiple prescriptions only with MME < 50)
ï‚· Reduces the opioids in the family medicine cabinet and subsequently reduces new opioid
addicts.
ï‚· Reduces “pill mill” opioid availability and reduces diversion of opioids
ï‚· Limited impact on the provision of opioids for patients with moderate pain
ï‚· No impact on patients receiving stimulant such as Attention Deficit Disorder medications
​
Thank you for consideration.
Sincerely,
​
​
Proposed Law With Modification
Federal Controlled Substances Act: Controlled Substances Prescriptions
(a) The refilling of a prescription for a controlled substance listed in Schedule II is prohibited.
(b)(1) An individual practitioner may issue multiple prescriptions authorizing the patient to
receive a total of up to a 90-day supply of a Schedule II controlled substance provided the
following conditions are met:
(i) Each separate prescription is issued for a legitimate medical purpose by an individual
practitioner acting in the usual course of professional practice;
(ii) The individual practitioner provides written instructions on each prescription (other than
the first prescription, if the prescribing practitioner intends for that prescription to be filled
immediately) indicating the earliest date on which a pharmacy may fill each prescription;
(iii) The individual practitioner concludes that providing the patient with multiple prescriptions
in this manner does not create an undue risk of diversion or abuse;
(iv) The issuance of multiple prescriptions as described in this section is permissible under the
applicable state laws; and
(v) The individual practitioner complies fully with all other applicable requirements under the
Act and these regulations as well as any additional requirements under state law.
PROPOSED ADDITIONAL SECTION
(vi) Each prescription shall be written for no more than 50 MME opioid equivalents as
calculated with a CDC or FDA calculator. The MME opioid equivalent for these multiple
prescriptions will be entered into a database that will be maintained at the expense of the
medical practitioner.
(2) Nothing in this paragraph (b) shall be construed as mandating or encouraging individual
practitioners to issue multiple prescriptions or to see their patients only once every 90 days
when prescribing Schedule II controlled substances. Rather, individual practitioners must
determine on their own, based on sound medical judgment, and in accordance with established
medical standards, whether it is appropriate to issue multiple prescriptions and how often to
see their patients when doing so
References
SUPREME COURT OF THE UNITED STATES
https://www.supremecourt.gov/opinions/21pdf/20-1410_1an2.pdf
XIULU RUAN v. UNITED STATES
No. 20–1410. Argued March 1, 2022—Decided June 27, 2022*
​
CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
Morbidity and Mortality Weekly Report (MMWR)
Recommendations and Reports