PHOENIX — A far-reaching plan designed to put a dent in opioid abuse cleared its first legislative hurdle Tuesday as a pain-management physician encouraged lawmakers to proceed, but with caution.
Dr. William Thompson told the House Health Committee that an increasing focus on the fact that chronic pain is a legitimate complaint has led to doctors who really “didn’t know what they were doing” prescribing pain medications.
Moreover, Thompson said 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 those concerns.
Tuesday’s vote sends the measure to the full House for debate, likely Wednesday; an identical bill is also set for debate in a Senate panel Wednesday.
The proposal includes a requirement for doctors in training to become educated on opioids, as well as a mandate that doctors who prescribe opioids receive continuing medical education on the drug.
Limits on initial prescriptions are included in the legislation: five days in most cases and 14 days following surgery. 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 that 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 said. 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.
Lawrence had concerns beyond the state getting involved in the physician-patient relationships. One involves the requirement that pharmacists must put opioids into bottles with a red cap.
That concerned Lawrence, who said 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.
State 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.
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 Vicodin, a drug that contains hydrocodone.
“It started a 10-year nightmare” of addiction, she said, with her son winding up in state prison. Now recovered, he has a felony record that makes getting a job and even an apartment difficult, Scanlon said.
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 could prescribe that long a dosage.