State lawmakers voted late Thursday to adopt changes in laws on opioids despite what some said are flaws and concerns by others that the plan won’t do much of anything to deal with the drug abuse epidemic.
The unanimous approval came just hours after the Republicans who control both the House and Senate picked apart the package that Gov. Doug Ducey presented to them Monday and asked that they give final approval in three days.
It wasn’t just the rush to make massive changes in Arizona law that concerned a few lawmakers who pointed out that many of the key provisions do not even take effect until next year. The bigger fear is that some of what’s in the package has not been well thought out.
One complaint deals with a provision designed to ensure that doctors do not provide larger doses than appropriate.
It absolutely prohibits giving patients more than 90 “morphine milligram equivalents” a day unless they fall into certain excepted categories like cancer patients and those in hospice. Doctors can prescribe such doses in other cases — but only if they first consult a board-certified pain management specialist.
Sen. Sylvia Allen, R-Snowflake, said that raises all sorts of concerns, ranging from who picks up the cost of the consult for patients without health insurance to how long it might take to get that second opinion, especially if the specialist actually wants to see the patient.
“It’s probably going to be a long wait,” said Sen. Nancy Barto, R-Phoenix.
The bigger question, Allen said, is having the state looking over the shoulder of medical professionals.
“Here’s a doctor who’s practiced for years, knows that patient, and now they have to get a second opinion,” she said.
“It’s kind of an insult to them,” Allen continued. “So I don’t like that at all.”
Sen. Rick Gray, R-Sun City, worried over a provision that will require all prescriptions for opioids to be done electronically. That is designed to cut down on forged paper prescriptions.
But Gray questioned whether that’s technically feasible, particularly for rural doctors.
“Some of this software isn’t even developed yet,” he said. Gray said it took the state of New York two years to get a similar system in place.
Rep. Regina Cobb, R-Kingman, called the requirement an “unfunded mandate, saying that setting up the system could cost doctors up to $20,000.
Sen. Steve Smith, R-Maricopa, said he had a problem with the concept of imposing an entirely new regulatory scheme on all doctors. Smith said he believes there are just a small number of “bad doctors” who are causing the problem by overprescribing highly addictive opioids.
“If you’re going to overburden the doctors you’re still not going to solve the problem,” he said.
Sen. Warren Petersen, R-Gilbert, agreed, saying the state is pushing ahead with new regulations that don’t address the underlying reasons of why people abuse drugs.
“Whenever government solves problems it doesn’t seem to work out too well,” he said. “I hope we’re realizing there are some things government can’t solve.”
That question of regulation also got the attention of Sen. Sonny Borrelli, R-Lake Havasu City, who openly wondered whether all the new laws and restrictions might have an unintended effect.
“I don’t want to restrict the ability of good doctors to do their job and force that patient (who needs painkillers) to black tar heroin,” he said.
Borrelli also said the bill is lacking a crucial provision: a state-run needle exchange program to keep addicts from sharing needles and possibly spreading HIV, “and then we have another epidemic.”
Rep. Noel Campbell, R-Campbell, worried about provisions which require veterinarians to report to police if they believe clients are seeking opiates for themselves instead of their pets. That same section then allows police to demand reports, all, Campbell said, without a court order.
“This is what we call a fishing expedition,” he said.
All the concerns — and the unanswered questions — also go to the question of why Ducey called a special session, insisting that lawmakers go from their first real look at the bill on Monday and final approval by the end of the day Thursday. Sen. John Kavanagh, R-Fountain Hills, pointed out that many of the key provisions do not even take effect until next year.
“If we’re not implementing this until 2019 I don’t know why we’re voting on this this afternoon,” he said. Even Majority Leader Kimberly Yee, R-Phoenix, conceded the risks of such rapid action.
“Sometimes when we rush through legislation there are consequences,” she said.
Not everyone saw the issue that way.
Sen. Bob Worsley, R-Mesa, said there is evidence of a real crisis, citing figures showing there has been a 74 percent increase in opioid deaths since he became a lawmaker in 2013.
“It’s highly addictive and it’s killing people,” he told colleagues. “I don’t know why we’re suddenly getting weak knees.”
And Sen. Karen Fann, R-Prescott, said she has no problem with new state laws, saying that whatever kind of self-regulation that is supposed to be going on in the medical community isn’t working, “forcing the government to step in and save some lives.”
Senate President Steve Yarbrough, R-Chandler, did not dispute any of the concerns or contentions of his fellow Republicans. But he urged lawmakers to adopt the plan now, saying any flaws can be fixed next year.
Even Smith, despite his concerns, said he’s willing to push this through.
“I think it’s important to make a statement,” he said.