A far-reaching plan designed to help put a dent in opioid abuse cleared its first legislative hurdle Tuesday as a pain management physician warned lawmakers to proceed — but be cautious.
William Thompson told members of the House Health Committee a key reason there is a crisis is because of policies set by government and others in the first place. That includes an increasing focus on the fact that chronic pain is a legitimate complaint.
But Thompson said that led to doctors who really “didn’t know what they were doing” prescribing pain medications.
And there’s something else.
Thompson said that many doctors are rated — and paid — based on patient satisfaction. He said that leads to a greater willingness of doctors to give patients the pills they want to make them satisfied by eliminating their pain.
He said that needs to be changed to empower doctors to say “no” as appropriate.
The legislation approved unanimously by the committee is designed to address at least some of that.
It includes both a requirement for doctors in training to get educated on opioids and a mandate that doctors who prescribe opioids to get ongoing continuing medical education on the drug.
There also are limits on initial prescriptions: five days in most cases and 14 days following surgery. And the measure has various reporting requirements designed to keep patients from “doctor shopping.”
While testifying in support of the measure, Thompson, a pain management specialist, urged lawmakers to take care.
“We’re here in part because of well-meaning policy that was not well thought out,” he said. That started with making “pain” a vital sign, with people interested in the suffering of patients.
“And then creative marketing by drug companies created this problem,” Thompson said.
What concerns him is now the Legislature is creating yet more policies with the goal of saving lives.
“I want to make sure that we think this through, like we have with stakeholder meetings, and make sure what our policy here doesn’t have unintended consequences,” Thompson said.
The new regulations, particularly about what doctors can prescribe in pills and dosages, drew some concerns from Rep. Jay Lawrence, R-Scottsdale.
“There’s no profession on this earth that wants to be regulated any more,” Thompson conceded. But he said there are “thought-out” exemptions that allow for doctors to prescribe higher doses, and for longer periods of time, in situations where that is necessary.
He said, though, that lawmakers also need to recognize that some of the problem started with the medical community.
“In the case of opiate management, I think there have been a contribution to our crisis of people who are not well enough trained in these drugs, did not have continuing medical education, and quite frankly didn’t see what they were creating,” Thompson told lawmakers. But even more basic than that, he said, doctors were “doing what they were taught.”
Lawmakers got a real-world story from Dawn Scanlon who told of her son, 17 at the time, shattering his elbow. After the surgery, the doctor gave him two 30-day prescriptions of of Vicodin, a drug that contains hydrocodone.
“It started a 10-year nightmare,” she said, with her son winding up in state prison. Now recovered, Scanlon said he has a felony record that makes getting a job and even an apartment difficult.
Such a 30-day supply for someone who had not been on opioids for the past 60 days would be prohibited under the legislation. But Rep. Regina Cobb, R-Kingman, questioned whether even that 14-day allowance following surgery was appropriate.
Cobb, a dentist, said a “surgical procedure” would include extracting a tooth. She wants the measure altered to provide a better — and narrower — definition of when a doctor would be able to prescribe that long a dosage.
Lawrence had concerns beyond the state getting involved in the physician-patient relationship. One involves the requirement that pharmacists must put opioids into bottles with a red cap.
That concerned Lawrence who said that people going through a home for sale have a tendency to look into medicine cabinets.
“I think there are too many instances where the red cap says, ‘Wow, I want that,’ ” he said.
Health Director Cara Christ said the red cap requirement is designed to make sure that patients realize this is a special drug that requires special attention. She told lawmakers that, ideally, people would keep them somewhere other than a medicine cabinet.
Christ acknowledged she knows of no other state with a similar requirement.
Tuesday’s vote sends the measure to the full House for debate, likely later Wednesday; an identical bill is also set for debate in a Senate panel today.