Proposed federal limits to opioid prescriptions draw opposition from physicians and patients

A last-minute coalition emerged on Monday to oppose a new CMS rule limiting opioid prescriptions. The rule would restrict opioid doses to Medicare patients to the equivalent of 90 milligrams of morphine per day.

A last-minute coalition emerged on Monday to oppose a new CMS rule limiting opioid prescriptions. The rule would restrict opioid doses to Medicare patients to the equivalent of 90 milligrams of morphine per day. A group of doctors, pain patients, and public health experts—including three who contributed to the CDC's own prescribing guidelines—have voiced their opposition via comment, letter, and social media. Dozens of academics, doctors, and editors of pain journals have signed onto a letter claiming the proposed rule constitutes overreach by CMS into medical treatment and would carry serious consequences for the 1.6 million Medicare beneficiaries who reached that threshold for at least 1 day in 2016. "There are a lot of Medicare providers that already do very aggressive dose control now," said Stefan Kertesz, a professor at the University of Alabama-Birmingham who focuses on addiction and works with a variety of chronic pain patients. "We know what real opioid safety looks like. This is not that." Opponents of the rule call it a one-size-fits-all response to external pressure on CMS, and one that takes decision-making power away from doctors. The rule, set to be finalized April 2, is the first daily opioid dose limit proposal issued under the leadership of new CMS administrator Seema Verma.