New Mexico legislative debate shows extent of prescription drug dilemma
While the proposal failed to pass before the Legislature adjourned, it highlights the concerns and shows how far lawmakers might go to address the issue.
S.B. 159 would have mandated procedures relating to the prescribing and dispensing of certain prescriptions for opioid medications to treat pain. Saying that the state has one of the highest drug overdose rates in the nation, the sponsor proposed a new provision in the Drug, Device and Cosmetic Act that would have required patients to sign consent forms and compelled physicians to alert them to the risks.
Additionally, the legislation would have prohibited refills on opioids. Opioid prescriptions would have been limited to seven days for acute conditions and 30 days for indications other than cancer, chronic pain, and hospice patients. The diagnosis would have had to have been on the prescription label for patients with chronic pain.
The legislation was sponsored by state Sen. Bernadette M. Sanchez and had the support of Gov. Susana Martinez. But several medical organizations voiced opposition.
The New Mexico Medical Society said the restrictions would:
- Impede appropriate pain treatment, especially among patients with scheduling issues who would be limited by the prescription amounts.
- Interfere with the patient-physician relationship by creating a cookie-cutter approach.
- Decrease access to care. Some physicians could be discouraged from prescribing narcotic medications because of the additional regulations, the organization said.
- Ignore the process already in place, including drug testing patients, limiting refills to three months, and checking the prescription drug monitoring program for patients who engage in doctor and pharmacy shopping.
- Create a barrier to providing care for patients. "How are patients who are bedridden, aged, or homebound supposed to come in every month when coming in every three months is a hardship?" the organization said.
- Increase paperwork with no indication of effectiveness.
- Compromise patient privacy.
- Create confusion.
The American Pain Foundation asked that passage be postponed until next year to give interested parties time to develop a consensus about what policy changes would address the problem. Likewise, the American Academy of Pain Management lobbied against the bill and said the 30-day legislative session did not provide enough time to develop a thoughtful approach.
Chief among its concerns was that the additional burdens would lead some prescribers and dispensers to "simply get out of the business of pain management." It noted what it said are precedents in other states, including:
- Florida -- Less than a year after passing legislation to address pill mills, "we now receive regular reports that patients are having to drive hours to find physicians to treat them and sometimes can't find pharmacies to fill their prescriptions."
- Ohio -- Before new procedures and restrictions addressing pill mills were finalized, "there were numerous reports of patients showing up in clinics and emergency rooms in acute opioid withdrawal because their prescribers had abruptly dropped them as patients."
- Washington -- While new rules include "many good practices for opioid prescribing," the provider community is baffled about what is required of them and "fearful that they will inadvertently violate the rules and lose their licenses. Their response has been to opt out of pain treatment in droves."
Sen. Sanchez said she will continue to work on the issue.
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March 12, 2012
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