Legislature approves opioid restrictions
He’s now a member of the support group Bridge to Hope, which is attracting new families weekly.
He added that Harrisburg should next improve the rehabilitation system, because those who recover “become such valuable, positive people in society.”
Last year 3,383 Pennsylvania residents died from overdoses, and 81 percent of those deaths involved heroin, fentanyl, prescription opioids or some combination of those. Experts agree that many people who became hooked on prescriptions progressed to heroin. Although other states started to curb prescribing years ago, Pennsylvania trailed until this year, and consistently disciplined fewer rogue doctors, the Pittsburgh Post-Gazette reported in May.
On Wednesday, in a string of unanimous votes, the General Assembly began to catch up. The four bills include six key planks.
Patients in emergency departments should no longer be prescribed more than a week’s worth of opioids, unless practitioners document that there is no alternative to a longer prescription. Emergency practitioners won’t be allowed to write refills for opioid prescriptions. Practitioners who ignore the new rules could face discipline against their licenses. The Pennsylvania College of Emergency Physicians supported the bill.
Similarly, a bill by Mr. Yaw bars doctors from prescribing more than one week’s worth of opioids to minors, with exceptions for cancer and a few other circumstances. In most cases, doctors prescribing opioids to minors would have to first assess whether they were being treated for substance abuse, disclose the risks of addiction and drug interactions, and get written consent from the parent or guardian.
Doctors will be required to check a database of patient drug histories every time they prescribe an opioid or a benzodiazepine tranquilizer, such as Xanax. That amends a law that took effect in August required that they check the database the first time such drugs were prescribed.
Medical colleges must offer courses on pain management and the risks of, and alternatives to, opioids, under legislation sponsored by Sen. Thomas Killion, R-Delaware-Chester.
People who have had a substance abuse problem, or are for any reason worried that a doctor may offer them narcotics, can put themselves under a “voluntary nonopioid directive” that would remain in their medical file. A practitioner who “recklessly or negligently” offered opioids to such a patient anyway might face a license suspension or fine.
Even experienced doctors who prescribe controlled substances must periodically take two hours of professional education in pain management, addiction identification or the proper use of opioids, under another bill by Mr. Yaw.
Mr. Marks said the Legislature should have also demanded that insurers increase coverage for drug rehabilitation. This year’s state budget includes $20 million in new funding for treatment, including 45 Centers of Excellence meant to treat more than 10,000 people annually, but the number of treatment slots available is believed to be a fraction of the need.
“That’s the next step,” said Mr. Killian. “We have to make sure there are beds for these folks when they are ready to get clean, and there are the counselors there to help.”
Though doctors generally don’t like laws restricting their practices or adding to their workloads, some have said that they understand the Legislature’s efforts under the circumstances.
“Western Pennsylvania is an epicenter of all kinds of prescription opioid problems,” said Dr. Ajay Wasan, vice chair of UPMC Pain Medicine. “There are a lot of lives at stake. Public safety is really important.”
He said that the legislation shouldn’t change his practice. UPMC has for several years moved toward an approach to pain treatment in which opioids are just one of the available tools, he said, adding that some insurers reimburse non-opioid treatments “very poorly.”
Societal efforts to curb opioids are already swelling his practice, he added. “We are definitely seeing a lot more patients come to us, because they are being taken off of their opioids by another physician,” he said. Sometimes, that physician’s decision was appropriate, but other times it unnecessarily hurts the patient, he said.
John Hindman, who lost his son last month to an addiction that started with pills, said he’s gratified that there’s “a bit of a groundswell” to address the problem, noting that it took “parents that are willing to speak up and speak out and be honest about what’s happened to their children.”
Even though opioid curbs may mean fewer addicts in the long run, he said, they will probably drive some current pill abusers to heroin and fentanyl.
“This is going to get far worse before it gets better,” said the Whitehall contractor. “It’s going to take a little bit of time, simply because of how much product is out there, both legally and illegally.”