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The state agency that runs Vermont's Medicaid health insurance program announced its intention to limit prescriptions for opiate painkillers starting Tuesday. But it quickly reversed the new rule Wednesday, citing miscommunication.

The Department of Vermont Health Access said it would limit first-time prescriptions for short-acting opiates to a 10-day supply. Doctors would need to fill out additional approval paperwork if their patients needed painkillers for longer.

Dr. J. Scott Strenio, the medical director for the department, told medical providers in a letter early Wednesday that they were "encouraged to prescribe the fewest number of dosage units for the shortest period of time as is clinically appropriate."

Steven Costantino

Strenio said short-acting opiates are meant to treat acute pain, which takes "days to weeks" to resolve, and the rule would prevent misuse of leftover pills. Oncology doctors, who treat cancer patients, would not have had to follow the rule.

"This letter was based on an internal miscommunication and is hereby retracted," said Steven Costantino, the commissioner of the Department of Vermont Health Access, in an advisory later Wednesday.

The department had created the rule separately from S.243, the opiate addiction bill that Gov. Peter Shumlin signed into law as Act 173 on June 8. The Vermont Medical Society quickly sent out an email blast telling members about the change and contacted lawmakers.


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Paul Harrington, the executive vice president of the Vermont Medical Society, which is loosely affiliated with the American Medical Association, said he opposed the rule the department announced. He said Medicaid patients were going to have different rules from patients using other forms of insurance.

"The process laid out in Act 173, where the commissioner of health sets regulations in consultation with clinicians and others, is the one that should be applied to all Vermonters irrespective to how they get their insurance," Harrington said.

In his 2016 State of the State address, Shumlin proposed limiting painkiller prescriptions to 10 pills per patient after a minor procedure. He has advocated against prescribing OxyContin for children as young as 11 and has said doctors hand out similar painkillers "like candy."

Costantino said his department would work with the Vermont Department of Health under Act 173 to help limit opiate prescriptions. He said the law's new Controlled Substances and Pain Management Advisory Council will meet July 21 to start collaborating on a way to lower the number of opiates prescribed.

"Following that meeting, a proposed rule will be posted on the Department of Health's website and there will be a noticed public hearing and an opportunity to comment in person, via email, letter or phone," Costantino said.

The new prescribing rules likely would go into effect in 2017, he said.