New opioid law restrictions creating pain for docs

Well, that didn’t take long.

Only three days after a new law dictating to doctors how to handle opioid prescriptions took effect, doctors are complaining about the excessive paperwork and the potential risk to their licenses for simple mistakes, according to the Las Vegas newspaper.

Doctors at a Wednesday meeting complained that regulations are vague as to what actually constitutes a violation.

The law attempts to prevent oversubscribing of opioids, though every patient is different and causes of pain are difficult to pinpoint and levels of pain are relative.

Here is an example of how the law is being explained to doctors:

  1. Rules for First-Time Prescriptions of Controlled Substances For The Treatment Of Pain: AB 474 includes guidelines that prescribers must follow prior to writing an initial prescription, which include having a bona fide relationship with the patient; establishing a preliminary diagnosis and treatment plan; obtaining and reviewing the patient’s Prescription Drug Monitoring Report; and discussing non-controlled substance treatment options with the patient. The practitioner must also perform a patient risk assessment, which consists of reviewing the patient’s medical history, conducting a physical examination and assessing the patient’s mental health and risk of abuse, addiction and dependency.If after review and assessment of the patient, the prescriber writes a prescription it can be for no more than 14 days for acute pain, and no more than 90 morphine mili-equivalent for opiate-naïve patients. Also, the patient must complete a written informed consent form stating that, among other things, they understand the potential risks and benefits of using the controlled substance.

  2. Prescribing After 30 Days: A practitioner who prescribes a controlled substance to treat pain for more than 30 days must enter into a Prescription Medication Agreement with the patient. The agreement must be part of the patient’s record and must include goals of the treatment. Patients also must agree to use the controlled substance as prescribed, not to share the medication, and to inform the practitioner of other prescriptions or substance uses that may affect the prescription.

  3. Prescribing After 90 Days: A practitioner who prescribes a controlled substance to treat pain for more than 90 consecutive days must now determine an evidence-based diagnosis for the cause of the pain; complete a risk of abuse assessment; continue an ongoing discussion about the plan with the patient; and obtain and review the patient’s Prescription Drug Monitoring Program report at least every 90 days during treatment.

  4. Prescribing After 365 Days: A practitioner should not prescribe a controlled substance to a patient who has already received 365 days’ worth of that controlled substance for a particular diagnosis in any given 365-day rolling period. The practitioner may choose to prescribe a larger quantity than the patient needs for the treatment period, so long as the practitioner documents their rationale in the patient’s medical record.

Clear as mud?

One doctor complained that it now takes an extra 10 minutes per patient just to fill out forms. Time is money.  And that is in the first week. Wait till the 30-, 90- and 365-day rules kick in.

In an op-ed in USA Today six months ago, a doctor offered this suggestion to lawmakers:

If we are really interested in addressing the opioid overdose problem, we should get government out of the way and let doctors be doctors. Trust health care providers to follow their best judgment, use “harm reduction” strategies and abide by their oath to ease pain and suffering and “do no harm.”

He also said aggressive laws drive patients into the illegal market, where drugs may be laced with dangerous additives.

In fact, the Las Vegas paper quoted a Reno doctor as saying, “Just the other day, I had a patient tell me point-blank they’re not going to sign the forms, they don’t want to do initial testing, and they would just go to the street to get their narcotics.”

Lawmakers, heal thy selves.

Doctors complain about new law restricting opioid prescriptions. (R-J pix)





11 comments on “New opioid law restrictions creating pain for docs

  1. Bill says:

    As usual, in the zeal to ride the newly discovered “crisis” facing society, well meaning politicians have rushed into the breach and enacted “emergency” legislation, once again ignoring the unintended consequences of their actions.

  2. Anonymous says:

    Fascinating topic really. Forced me once again to do just a little “work” and find out some stuff i thought someone else might be interested in. Great article about the Sackler family who, i must confess i never heard of and although the first part of the article is the kind of history some around here might not appreciate it, it did interest me.

    The really good part though was about how they got the doctors to start prescribing Oxy drugs to the world:

    “It was doctors, though, who received the most attention. “We used to fly doctors to these ‘seminars,’ ” said Sherman, which were, in practice, “just golf trips to Pebble Beach. It was graft.” Though offering perks and freebies to doctors was hardly uncommon in the industry, it was unprecedented in the marketing of a Schedule II narcotic. For some physicians, the junkets to sunny locales weren’t enough to persuade them to prescribe. To entice the holdouts—a group the company referred to internally as “problem doctors”—the reps would dangle the lure of Purdue’s lucrative speakers’ bureau. “Everybody was automatically approved,” said Sherman. “We would set up these little dinners, and they’d make their little fifteen-minute talk, and they’d get $500.”

    Between 1996 and 2001, the number of OxyContin prescriptions in the United States surged from about three hundred thousand to nearly six million, and reports of abuse started to bubble up in places like West Virginia, Florida, and Maine. (Research would later show a direct correlation between prescription volume in an area and rates of abuse and overdose.) Hundreds of doctors were eventually arrested for running pill mills. According to an investigation in the Los Angeles Times, even though Purdue kept an internal list of doctors it suspected of criminal diversion, it didn’t volunteer this information to law enforcement until years later.”

    So, this whole “bad gov’ment” “great free market” stuff is once again just so much nonsense. This private company bought and paid for all those great free market guys, who then overprescribed drugs, cause that’s where their bread was buttered, and lots of people died (more than died in car accidents last year).

    But you’ll probably want to read it yourselves so…

  3. Rincon says:

    Good point, anonymous. Veterinary medicine has greatly liberalized use of pain control drugs in the past 20 years or so, and the same is true for human medicine. In my profession, the practice of prescribing pain medicine after pain is evident is frowned upon. We’re supposed to prevent it in the first place. I don’t know if opinion leaders in our profession were bribed as in the human medical community, but they pushed very hard for liberal pain control. Seems to be the same in human medicine. After having an ankle pinned, I was advised by the surgeon that I should take the prescribed narcotics even if not painful because he said it’s more effective to prevent pain than to control it. That may be true, but I didn’t seem to need them and took only two does. I had a some pills left a few years later when I broke my collarbone, which was more painful and required a more extensive surgery. I got the same advice, but just took ibuprofen for a couple days and never needed the narcotic. Thirty years ago, I was told to ask for a narcotic prescription only if I needed it. Quite a difference.

    I’m not so sure too much government is the problem here, but rather a lack of proper government action. From what I understand, it’s common for addicts to visit several doctors in a day to load up on prescriptions. With the recent adoption of a common medical record database accessible by most health care providers, it doesn’t seem a stretch for computers to keep track of each individual’s prescriptions, not just to prevent substance abuse, but to catch incompatible drugs being accidentally prescribed together and to catch any prescriptions improperly filled. Easier and possibly more effective than having every doctor jump through some hoops which any addict will elude anyway. Don’t say it’s too hard to do. Google, You Tube, Amazon, and others keep track of your entire Web history with them. Credit card companies keep track of every little financial event in your life. Keeping track of prescription sales shouldn’t be all that hard.

  4. deleted says:

    6500 pills, per person, per year, and the company just kept sending in more and more and more. And never alerted anyone.

    50 people per 100,000 people dying of overdoses each year as the doctors who are paid off to prescribe get richer, and the drug company that makes the drug gets richer.

  5. Steve says:

    Nice to see “deleted”, or Patrick or whatever it is next, show support for “The Donald” and his SOTU call for reigning in drug manufacturer pricing.

  6. Anonymous says:

    God Bless those free marketers eh?

    They push their drugs then, after they made their mints what do they do? DECLARE BANKRUPTCY!

    God Bless America!

    Of course the same Sackler family that ran this cartel, was just discovered wiring over ONE BILLION DOLLARS out of the country. Takes the pain out of their time of trouble I’m assuming.

    Capitalists are just plain ole evil man.

  7. It’s their fault it became a street drug?

  8. Steve says:

    Yeah and those evil vape manufacturers need to be jailed too!

  9. While pot is now legal.

  10. Anonymous says:

    Of course it’s their fault Thomas.

    They’re not wiring money out of the country secretly and bankrupting the company just because it’s a nice day.

    Geez man.

  11. Steve says:

    The bankruptcy is an integral part of the agreement with those states that have signed on.
    It requires the family to pay out of pocket some 3 billion and the company become a revenue generator for the states from then on.

    Oh well, for some dictators, only total and complete devastation of their sworn enemy is acceptable.

    lookin’ at you “Patrick”

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