A po­ten­tially dan­ger­ous op­tion that would gen­er­ate an­other kind of pill mill epi­demic

Sun Sentinel Broward Edition - - Opinion -

As a for­mer state sen­a­tor and chair­woman of the Se­nate Com­mit­tee on Chil­dren, Fam­i­lies and El­der Af­fairs and as a mem­ber of the Statewide Drug Pol­icy Ad­vi­sory Coun­cil, I am deeply con­cerned about a new fed­eral law that could take us back to the days of pill mills, and cost lives.

The fed­eral law in ques­tion is called the Sub­stance Use-Dis­or­der Preven­tion that Pro­motes Opi­oid Re­cov­ery and Treat­ment (SUP­PORT) for Pa­tients and Com­mu­ni­ties Act, and it does a lot of good things to help stop the scourge of opi­oid ad­dic­tion in our na­tion.

But there is one vi­tal el­e­ment that our Florida Depart­ment of Health must pay spe­cial heed to.

The law al­lows – al­lows but does not (thank­fully) man­date – a non-pre­scrib­ing physi­cian to ad­min­is­ter a spe­cial type of nar­cotic to some­one who is not his or her pa­tient.

Imag­ine one doc­tor would be re­spon­si­ble for the pa­tient and hold the pre­scrip­tion pad but an­other doc­tor would see this pa­tient to ad­min­is­ter the sched­uled con­trolled sub­stance.

This could end up be­ing a very bad and very dan­ger­ous idea in our state. Why?

Hav­ing worked ex­ten­sively on pill mill leg­is­la­tion in our state, I worry that this could spawn a whole new kind of pill mill.

One where that sec­ond doc­tor, who may or may not be re­spon­si­ble for the first doc­tor’s pa­tient, would not be DATA 2000 ed­u­cated and waivered — and yet would be in possession of the con­trolled sub­stance (not just the pre­scrip­tion pad).

And he or she could be stock­ing and ad­min­is­ter­ing the con­trolled sub­stance all day long to pa­tients.

The ini­tial doc­tor — with the pre­scrip­tion pad — has a fed­er­ally man­dated limit on the num­ber of pa­tients he sees. In stark con­trast, the ad­min­is­ter­ing physi­cian, in possession of the highly di­verted, high street value nar­cotic — would face no such lim­its.

Why would the fed­eral gov­ern­ment imag­ine such a sce­nario and cre­ate such a crazy, con­vo­luted and po­ten­tially dan­ger­ous frame­work for treat­ing pa­tients with a sub­stance use dis­or­der? A frame­work fraught with all sorts of un­in­tended con­se­quences? I can’t say.

What I can say — and know from ex­pe­ri­ence — is that this raises the specter of peo­ple lined up all down the street and around the cor­ner, wait­ing to get an in­jec­tion from a non DATA 2000 doc­tor who isn’t even these pa­tients’ doc­tor.

And what if the pa­tient doesn’t show up? How will this so-called ad­min­is­ter­ing doc­tor re­turn the drug? And will he or she re­turn it to the pre­scrib­ing doc­tor? To the phar­macy? Phar­ma­cies do not usu­ally ac­cept nar­cotics back into in­ven­tory. So maybe they’ll just keep it? For how long? Or sim­ply ad­min­is­ter it to the next pa­tient in line? That last one is il­le­gal.

And how will all that be tracked in our state’s PDMP? How will DEA keep track? Most wor­ri­some of all, a pa­tient could be in­tox­i­cated or us­ing an­other nar­cotic when he shows up to this ad­min­is­ter­ing doc­tor’s of­fice and the very drug used to help pa­tients break the cy­cle of ad­dic­tion could ac­tu­ally kill them!

Florida en­sures that this spe­cial class of drugs (known as “Med­i­ca­tion As­sisted Treat­ment” or MAT) is pre­scribed by spe­cially trained physi­cians (known as DATA 2000 doc­tors) and we do not con­tem­plate such an open-ended de­liv­ery scheme.

If this pro­vi­sion is al­lowed to go into ef­fect in Florida, we could see more un­nec­es­sary deaths, more law­suits and a chaotic mess on our hands.

The good news is that Florida does not

have to al­low this new pro­vi­sion and in fact, the Depart­ment could sim­ply let DATA 2000 physi­cian know that we are “sta­tus quo” un­til fur­ther no­ti­fied.

The Depart­ment of Health should then re­view our laws, reg­u­la­tions and rules through the Board of Medicine or the leg­is­la­ture could ex­am­ine this and pass tough new laws to pro­tect doc­tors and pa­tients alike.

In ei­ther case, safety should come first. And, no mat­ter which path they take, we must al­ways keep in mind that these are po­ten­tially lethal con­trolled sub­stances and we should never let them out of our control.

Un­for­tu­nately, this one pro­vi­sion of the SUP­PORT Act — al­low­ing con­trolled nar­cotics to be out of a doc­tor’s control — is just not a good thing.

By Eleanor So­bel

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