Amid opposition from physicians, Wolf signs bill tightening opioid prescription rules

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Patients seeking treatment for chronic pain will have to enter written agreements with their doctors before they can receive prescriptions for opioids, under a bill that Gov. Tom Wolf signed into law just before the Thanksgiving holiday.

These “opioid treatment agreements” will require patients to say they understand the risks of highly addictive opioid drugs and consent to periodic drug testing to prove they aren’t misusing them.

The bill, sponsored by Sen. Ryan Aument, R-Lancaster, passed the majority-GOP state House and Senate in a series of party line votes last week to land on Wolf’s desk.

The proposal had near-unanimous support in the Legislature are recently as this spring. But Democrats in the House and Senate withdrew their support, saying Aument’s bill  would burden doctors and create new costs for patients that might not be covered by insurance. 

Professional associations representing Pennsylvania doctors also opposed the legislation. 

Aument’s bill will apply to patients who receive new opioid prescriptions to treat pain symptoms. It requires patients and their physicians to sign a statement outlining the purpose of the prescription — and the risks of opioid drugs, which include addiction and overdose. 

The agreements also require patients to be tested for illicit drug use before they start their prescription and consent to periodic drug tests assigned by their doctor over the course of their treatment. 

Aument said the new policy takes widely accepted best practices of medicine and codifies them in state statute. Its provisions were lifted directly from Pennsylvania’s prescribing guidelines — the non-compulsory set of best practices developed by the Department of Health. 

“There’s no silver bullet in the opioid crisis, but I think this is an important tool for medical providers and patients to make sure there is not misuse [of prescription opioids,]” Aument told the Capital-Star. 

Opposition from physicians

But the doctors who will have to follow the new law say lawmakers shouldn’t be in the business of legislating medicine.

The Pennsylvania Medical Society, the largest trade organization representing the state’s physicians, opposes any bill creating new mandates for the medical profession, John Gallagher, the doctor who chairs the Society’s opioid task force, told the Capital-Star. 

That includes Aument’s bill, which also faced opposition from emergency room doctors and private practitioners. 

“Medicine isn’t like following a cookbook,” Gallagher said. “Everything is different and you have to individualize treatment.” 

Gallagher said new medical mandates have proliferated in recent years as lawmakers try to address problems including the opioid epidemic and the Lyme Disease. These new requirements may be well-intentioned, but quickly become burdensome when medical practices change, Gallagher said. 

They also require doctors to spend more time on paperwork and less time with patients. They may also lead doctors to change their medical practices to avoid cumbersome requirements. 

That’s what Gallagher fears will happen when opioid treatment agreements become mandatory. 

“As much as we want to cut back on misuse, opioids have a role [in medicine,]” Gallagher said. “if you’re a physician saying, ‘I won’t prescribe them,’ patients will suffer a lot.”

Aument said he tried to provide flexibility in the law by creating multiple exemptions, including for patients with medical emergencies and those receiving end-of-life care.

But one of Aument’s Senate colleagues who previously worked as a trauma nurse said healthcare practitioners are already struggling under an ever-growing list of mandates. 

“Every time we add these restrictions and regulations, we are taking time away from the patient-doctor relationship,” said Sen. Maria Collett, D-Montgomery. 

Collett, who’s also an attorney, said the bill could increase costs for patients because it requires them to undergo multiple drug tests, but it doesn’t include a mandate for insurers to cover the costs. 

That could benefit medical testing companies such as  Quest Diagnostics, a private, for-profit chain that operates four laboratories and 163 testing centers in Pennsylvania. 

Quest Diagnostics wrote to lawmakers in the state House this month asking them to support the bill. Collett said she and other Senate Democrats took that as a sign the mandatory testing could benefit private industry more than patients.

“If a company like Quest supports this, you have to really look at why,” Collett said. “They stand to gain from this bill, and that’s a problem.”