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:
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.
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.
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.
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.