New Illinois Law Gives Doctors Freedom to Prescribe Opioids Without Dosage Limits
/By Crystal Lindell
Illinois State Senator Laura Fine (D) has seen the unintended consequences of the 2016 CDC opioid guideline first-hand.
After Fine’s husband Michael lost his arm in a horrific head-on collision, he suffered from chronic, residual pain known as “phantom limb” pain. She watched as he often struggled to get adequate pain care because his doctors were too scared to prescribe enough opioid medication.
“[His] pain is real. It’s so debilitating some days that he literally cannot get out of bed,” Fine told PNN. “His doctor needs the freedom to treat that pain.”
The 2016 CDC guideline, which was meant to address opioid overprescribing, ended up being too much of an overcorrection, and led many doctors to start under-prescribing pain medication, regardless of patient need. The guideline recommended that daily doses not exceed 90 morphine milligram equivalents (MME), a threshold that was soon adopted by Illinois and dozens of other states.
So when a state bill meant to address this issue came through the Illinois House and needed a Senate sponsor, Fine jumped at the chance.
The measure, which was approved unanimously by both chambers and signed into Illinois State law by Governor Pritzker on February 7, allows physicians to authorize prescriptions for opioids and other controlled substances without strict dosage limits:
“Provides that decisions regarding the treatment of patients experiencing chronic pain shall be made by the prescriber with dispensing by the pharmacist in accordance with the corresponding responsibility as described in federal regulations and State administrative rules.
Provides that ordering, prescribing, dispensing, administering, or paying for controlled substances, including opioids, shall not be predetermined by specific morphine milligram equivalent guidelines.
The Illinois law also seeks to protect patient confidentiality by preventing the release of prescription and treatment information without a legal order verified by the Illinois Department of Human Services or an administrative subpoena from the Illinois Department of Financial and Professional Regulation.
Many states currently allow the DEA and other law enforcement agencies access to patient information in their prescription drug monitoring programs (PDMPs). Some pharmacy chains even provide that information without a warrant or subpoena.
“Just because you’re in pain, that doesn’t mean you’re doing something wrong,” Fine said. “The last thing we want to do is to make the doctors or patients feel like criminals.”
Fine also said part of why the measure was so important to her was that when patients don’t have access to prescribed opioids, it can drive them to take extreme measures, such as self-medicating, self-harm, or going to the black market.
She hopes the new law will help people suffering from chronic pain receive the care they need, without barriers or misunderstandings.
Fine said she was surprised by how many pain patients wanted to work with her to get the law passed and how important the issue was to them. She’s happy to send the message that political advocacy does work.
STATE SEN. LAURA FINE (d)
“Getting this legislation passed, for them, was life changing,” Fine said.
One of those advocates was Kat Hatz, who posted about the Illinois legislation on Facebook after it passed, writing:
“This was a labor of love, & we had incredible sponsors, but it’s also a testament to the fact that people’s voices were heard. It will protect a vulnerable community, chronic pain patients & their healthcare practitioners, & it helps to address disparities in healthcare that pertain to the under-treatment of pain (for) women, people of color, disabled folks, & other traditionally disenfranchised communities.”
The Illinois State Medical Society (ISMS), which backed the bill, also wrote about the importance of the law as it was moving through the legislation process.
“The passage of this bill by the General Assembly is a win for physicians and patients, as too many doctors have become reluctant to prescribe opioid treatments to patients suffering from chronic pain out of fear of being criminalized or having their license suspended or revoked,” the society said in a statement.
The ISMS said many prescribers were worried that regulators and law enforcement would consider them “pill pushers” without understanding that the 2016 guideline is outdated. The CDC released an updated guideline in 2022 that gives doctors more flexibility in writing prescriptions.
“Every patient is different,” the ISMS said. “Pain treatment should be tailored to the needs of the individual.”
Fine said she hasn’t heard about other states taking up similar measures, but she hopes that Illinois can be an example.
“We all need an advocate,” she told me. “Being in pain isn’t something to be ashamed of.”
