FDA​ commissioner​ recommends​ limiting​ painkiller​ prescriptions

Addiction experts expressed concerns last week about a proposal by FDA Commissioner Dr. Scott Gottlieb to limit painkiller prescriptions from doctors.

During an appearance in front of the House Appropriations Committee on May 25, Gottlieb suggested that limiting prescriptions for painkillers could be a key tool in battling the opioid addiction crisis gripping the nation.

"What we need to do as a matter of public health is make sure patents are only getting exposed to opioids in appropriate clinical circumstances and only for the appropriate duration needed," Gottlieb told lawmakers. "So no more 30-day prescriptions for a tooth extraction."

The comments came two days after the Food and Drug Administration posted an announcement that Gottlieb directed his staff to explore "more forceful" efforts to curb the epidemic, including limiting prescriptions or requiring physician training on proper use of the painkillers as part of a treatment plan.

The FDA doesn't have the statutory ability to limit the amount of pills or the duration of prescriptions. However, the agency could deem prescriptions off-label if they're too large. That would give insurance companies an incentive to not pay for large prescriptions and discourage physicians from writing them, according to Dr. Nathaniel Katz, a neurologist and pain specialist.

"Doctors should have the last word, if they have adequate training," said Katz, founder and president of Analgesic Solutions, a clinical trial consulting firm.

Some of the FDA's suggestions could gain backing from addiction advocates. Katz said he supported the FDA's exploration to enhance physicians' opioid training. "Doctors have no idea how much to prescribe so they prescribe enough that they don't get a call back," Katz said.