New rules for painkiller prescriptions will impact tens of thousands of people dealing with a host of conditions, including women recovering from childbirth, patients suffering from broken bones, teenagers who need wisdom teeth removed and adults who require emergency surgery.
South Carolina patients who require opioid prescriptions will soon be limited to a five- or seven-day supply as both the state's largest private and public health insurers move to restrict access to the highly addictive painkillers.
Starting April 1, BlueCross BlueShield of South Carolina will limit short-acting opioid prescriptions to seven days. On May 1, the South Carolina Medicaid agency will limit opioid prescriptions to five days. Together, BlueCross BlueShield and Medicaid cover more than two-thirds of all South Carolinians.
In July, the Medicaid agency will withhold payment from doctors who don't comply with the new rule.
The South Carolina Medicaid agency wrote exceptions to the five-day rule. Doctors may prescribe a longer course of drugs for patients who have been diagnosed with chronic pain; cancer-related or sickle cell disease-related pain; or those who are receiving hospice care, palliative care or medication-assisted treatment for substance use disorder.
The changes follow a December executive order announced by Gov. Henry McMaster to curb prescription drug abuse in South Carolina. He declared the opioid epidemic a public health emergency.
"There's a silent hurricane going, and it's getting worse," McMaster said during the December press conference.
Opioid-related overdoses killed 616 people in South Carolina in 2016, the most recent year data is available.
Though the number of such deaths in South Carolina falls short of opioid overdose fatalities in other states, including Ohio, Maryland and West Virginia, the Palmetto State has one of the highest opioid prescribing rates in the country.
In 2016, South Carolina doctors handed out 89 opioid prescriptions for every 100 people, according to data published by the Centers for Disease Control and Prevention.
South Carolina Medicaid Director Joshua Baker said Medicaid patients are typically prescribed more than two weeks worth of medicine when they need an opioid.
This state isn't the first to impose time limits on these prescriptions, he said. In fact, some states have enacted a three-day limit.
Baker said the South Carolina Medicaid agency tried to strike the right balance in writing the new five-day rule. Officials don't want to propel patients to the emergency room when they run out of pain pills, he said. But they also don't want to inadvertently drive them to the street in search of cheaper, more dangerous drugs.
Similarly, BlueCross BlueShield of South Carolina wrote exceptions to its seven-day rule for cancer and sickle cell patients, as well as those in hospice care.
Dr. Matthew Bartels, chief medical officer for BlueCross BlueShield of South Carolina, advised that opioids should rarely be the first line of treatment for pain.
New research published Tuesday in the Journal of the American Medical Association found the use of opioids did not "result in significantly better pain-related function over 12 months" compared to non-opioid treatment, such as acetaminophen.