This is a guest article by Silvio Aladjem MD.

A new Michigan Law limits to 7 days the amounts of opioids doctors can prescribe patients suffering from acute pain. That includes broken bones, bad backs, short illnesses and most surgeries. After the initial treatment, there is a mandatory wait period of 7 days before the prescription can be renewed, if needed. The law does not specify if further renewals, alternating with dry periods of 7 days, are allowed It probably does not, but this may be argued. What does “bad backs” mean?

I understand where the law makers come from: the opioid epidemic is rampant in our country and there is rarely a week where someone, somewhere, does not die from an opioid overdose.  Addiction is rampant.

But that does not justify interfering with medical judgment, which may dictate continuation of therapy or the need to include other “diseases.

Broken bones are extremely painful. But a broken finger bone in a young patient is not the same as a broken pelvic bone in an elderly patient.  In the former, opioid is likely not needed but the law would allow it. In the later, arbitrarily discontinuing the therapy for 7 days, may not be possible and may qualify as poor medical care.  Same with surgical procedures. A hernia repair is not the same as trauma surgery after a major car crash.

What were they thinking? Make a political statement? Prepare for the next election to be able to appear as a caring politicians concerned about a national problem and tough on drugs? These very same politicians would not support a bill to treat the real addicts, the homeless or fund fundamental social programs we are lacking.

But the issues of such a law are deeper than appears at first sight. Doctors are now reluctant to prescribe opioids to real patients, in their offices or hospitals. Imagine a very busy practice which treats 40 to 50 patients daily. In a week that amounts to over 300 patients and in a month more than 1500. If only a fraction of these patients needs some sort of opioids, can you imagine how fast his or her practice will be flagged as “overprescribing”?  Legislating the right of a physician and treatments is criminal, inhumane or worse.

Law makers are supposed to write laws for the benefit of all. But they should know their limitations. Laws interfering with medical judgment is one of those limitations.

I don’t know if the lawmakers consulted with AMA or Michigan Medical Society as to potential repercussions of this law on the day to day medical care. I can’t believe that, if they did, the Medical Society supported such a law.

Do the lawmakers really believe that such a law will turn the tide of the national opioid crisis?  How does limiting the amount of opioid treatment in a patient undergoing surgery for a metastatic cancer, affect the use of heroin or cocaine in the street?

The way it looks to me, this law is an attempt at politicizing the issue and appear as “tough on drugs” in the next midterm elections. How foolish or short sighted can one be as a legislator? It looks that there is no limit.

At least I know how I will vote in the next midterm election.


SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI.  He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website,


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