Law­mak­ers tus­sle with bill to fight painkiller ad­dic­tion

Honolulu Star-Advertiser - - FRONT PAGE - By So­phie Cocke scocke@starad­ver­

With ad­dic­tion to pre­scrip­tion painkillers on the rise in Hawaii, state law­mak­ers pri­or­i­tized leg­is­la­tion this ses­sion aimed at cut­ting down on abuse and mak­ing sure that health care providers coun­sel pa­tients on the risks of opi­oid med­i­ca­tions. But as this leg­isla­tive ses­sion nears an end, law­mak­ers are still try­ing to come to an agree­ment on a bill, and the cur­rent pro­posal has stirred op­po­si­tion from doc­tors, drug pol­icy ad­vo­cates and com­mu­nity groups on the front lines of deal­ing with drug abuse. Se­nate Bill 505 would re­quire pre­scribers to coun­sel pa­tients about the risks of be­com­ing ad­dicted to and over­dos­ing on opi­oids, the risks of tak­ing the pills if preg­nant, and al­ter­na­tive treat­ment op­tions for pain, in ad­di­tion to other re­quire­ments, for ini­tial pre­scrip­tions. Pa­tients would also have to con­sent to pe­ri­odic urine drug screen­ings, ac­cord­ing to the lat­est ver­sion of the bill.

A treat­ment agree­ment in­clud­ing these risks would also have to be pro­vided in writ­ing and signed by the pre­scriber and pa­tient.

The mea­sure also lim­its ini­tial pre­scrip­tions of both opi­oids and ben­zo­di­azepines, ex­cept un­der cer­tain cir­cum­stances, to seven days. Com­monly pre­scribed opi­oids in­clude such painkillers as hy­drocodone and oxy­codone. Ben­zo­di­azepines in­clude tran­quil­iz­ers such as Val­ium and Xanax. Doc­tors say both can be addictive and, when used in com­bi­na­tion, can lead to lethal over­doses.

The seven-day limit for ini­tial pre­scrip­tions would be waived un­der a num­ber of cir­cum­stances, such as when a pa­tient has un­der­gone an op­er­a­tion or when some­one is in pal­lia­tive or hospice care.

A grow­ing cri­sis

Hawaii has seen a grow­ing rate of drug over­dose deaths in re­cent years. In 2008, deaths from drug over­doses sur­passed mo­tor ve­hi­cle fa­tal­i­ties for the first time, ac­cord­ing to data from the state Depart­ment of Health. Over­doses are be­ing fu­eled, at least in part, by opi­oid abuse.

Be­tween 2010 and 2014, opi­oid pain re­liev­ers ac­counted for 35 per­cent of the drug over­dose deaths, a fig­ure that may ac­tu­ally be un­der­es­ti­mated due to data gaps, ac­cord­ing to the Health Depart­ment. In re­cent years, more than 150 peo­ple have died an­nu­ally in Hawaii from opi­oid over­doses.

Sen. Josh Green (D, Naalehu-Kailua-Kona), who is also an emer­gency room doc­tor on Hawaii is­land, has sup­ported leg­is­la­tion tar­get­ing opi­oid abuse for sev­eral years and is a co-spon­sor of Se­nate Bill 505.

He said he’s seen a rise in ad­dic­tion to pain pills in re­cent years, as well as pa­tients turn­ing to street drugs, in­clud­ing heroin and metham­phetamine, if they can’t get pre­scrip­tion drugs. He said that the in­formed con­sent por­tion of SB 505 was par­tic­u­larly im­por­tant and that the med­i­cal com­mu­nity needed to be more aware that ini­tial pre­scrip­tions for painkillers can lead to more sig­nif­i­cant prob­lems. “We as a med­i­cal com­mu­nity need to own this prob­lem, and if it means a lit­tle ex­tra work or some ex­tra fol­low-up vis­its, I think it is prob­a­bly worth the sac­ri­fice of time to make sure that peo­ple aren’t get­ting ad­dicted or get­ting too many pills,” he said. Amer­i­cans con­sume about 80 per­cent of the global opi­oid sup­ply, ac­cord­ing to the Amer­i­can So­ci­ety of In­ter­ven­tional Pain Physi­cians. And a re­cent federal study found that more than 1 in 3 Amer­i­can adults were pre­scribed painkillers in 2015.

“Amer­ica re­ally has lost its way on ad­dic­tion of these med­i­ca­tions,” said Green. “That is why we are hav­ing leg­is­la­tion. It is not usual to have leg­is­la­tion on health is­sues like this, but there has been this big surge of that across the coun­try be­cause of the num­ber of ad­dicts. So now we are forced to ac­tu­ally reg­u­late the med­i­cal com­mu­nity.”

“It is tough as a doc­tor for me to be a part of that, but I saw it from the pol­icy per­spec­tive,” Green con­tin­ued. “It’s just far too many peo­ple were be­com­ing ad­dicted.”

Dis­cord over so­lu­tion

How­ever, there’s still no agree­ment among the med­i­cal

com­mu­nity, drug pol­icy ex­perts and leg­is­la­tors about how to ad­dress the ris­ing prob­lem. Se­nate Bill 505 has re­ceived push­back from groups such as The Drug Pol­icy Fo­rum of Hawai‘i and the CHOW Project (the Com­mu­nity Health Out­reach Work to Pre­vent AIDS Project), which as­sists peo­ple with drug prob­lems, as well as groups rep­re­sent­ing lo­cal doc­tors.

The Drug Pol­icy Fo­rum of Hawai‘i has ar­gued that the seven-day limit on pre­scrip­tions is ar­bi­trary and could run counter to pa­tient needs, es­pe­cially given doc­tor short­ages in ru­ral ar­eas. The pol­icy group has also said that the mea­sure is too fo­cused on the sup­ply side of the prob­lem, as op­posed to suf­fer­ing pa­tients.

Our “con­cern re­mains that this ar­bi­trary limit could push pa­tients in need of pain re­lief to­wards more dan­ger­ous drugs,” wrote Carl Bergquist, the non­profit’s ex­ec­u­tive di­rec­tor, in tes­ti­mony on the bill. Groups such as the Hawaii Med­i­cal As­so­ci­a­tion, the Amer­i­can Col­lege of Emer­gency Physi­cians and the Amer­i­can Congress of Ob­ste­tri­cians and Gyne­col­o­gists in Hawaii have raised con­cerns that physi­cians could be charged with felonies for non­com­pli­ance with the mea­sure, or if they make a mis­take. They’ve asked that the mea­sure be amended to en­sure this isn’t the case. ACOG also raised con­cerns that the bill in­ter­feres with the physi­cian-pa­tient re­la­tion­ship and pa­tient con­fi­den­tial­ity. The bill was heard in con­fer­ence com­mit­tee on Fri­day, where se­lect mem­bers of the House and Se­nate ham­mer out fi­nal dif­fer­ences on bills.

Sen. Ros­alyn Baker (D, West Maui-South Maui), chair­woman of the Com­merce, Con­sumer Pro­tec­tion and Health Com­mit­tee, said that con­fer­ees were “mak­ing some progress” on the mea­sure and planned to clean up some of the bill’s lan­guage and re­view new Health Depart­ment rec­om­men­da­tions. The con­fer­ence com­mit­tee is sched­uled to take up the mea­sure again on Mon­day.


The state sen­a­tor and ER doc­tor says the med­i­cal com­mu­nity needs to do its part to curb opi­oid ad­dic­tion Josh Green:


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