I-Team: Nevada doctors will have to comply with new opioid regulations on Jan. 1

http://www.lasvegasnow.com/news/i-team-nevada-doctors-will-have-to-comply-with-new-opioid-regulations-on-jan-1/876634765

LAS VEGAS – As of New Year’s day, Nevada doctors who prescribe opioid medication will have to comply with new regulations. On Tuesday night, physicians received a crash course on how the rules will work.

The new law, Assembly Bill 474, was initiated because of concerns about an opioid epidemic. As 8 News NOW has been reporting over the last several weeks, there is another side to the opioid issue, so what happens to legitimate pain patients?

The news release which announced the event declared that Nevada has the fourth highest overdose mortality rate in the country that is, the state did back in 2010. However, a lot has changed in the last seven years.

Opioid prescriptions in Nevada have dropped every year since 2011 while overdoses and hospitalizations have gone up, so how can that make sense?

At city hall Tuesday night, the medical society helped prepare local physicians for the impact of Assembly Bill 474. The law is not as draconian as some opioid crackdowns enacted elsewhere, but it means any doctor prescribing opioid medication must provide a detailed medical history so that pharmacists can decide if the prescription should be filled.

State officials say Nevadans are dying from prescription opioids, even though about 90 percent of overdose deaths involve illicit drugs including heroin, meth, fentanyl, alcohol and other substances. Chronic pain patients in Nevada already sign contracts which require urine screening and other conditions.

Patients were not part of the panel Tuesday night but were in the audience because they worry the new requirements will turn a bad situation worse.

“It’s very burdensome for prescribing physicians, and I’m really afraid what’s going to happen is that a lot of doctors are just going to quit prescribing these opioid pain medications altogether because they don’t want to be bothered with it,” said Rick Martin, chronic pain patient. “They don’t have enough time to deal with patients as it is, and there are not enough pain management doctors in town or elsewhere to handle the patients thrown under the bus by primary care physicians who don’t want to treat them anymore.”

Martin, a retired pharmacist, says millions of legitimate pain patients are being punished because of the actions of addicts who overdose, mostly on illicit drugs. Under Nevada law, pharmacists can already decline to fill prescriptions, though they are supposed to consult with the doctor first.

As reported in our recent series, the other side of opioids, Nevada pharmacists already use patient profiling to decide if they will fill opioid prescriptions. They also have an unofficial blacklist containing the names of doctors.

   This report stated that they had previously reported that Nevada Pharmacists are “profiling” pts as to who is “worthy”, in their opinion, to have a controlled substance filled. Has the Nevada legislature put responsibilities on Pharmacists that exceeds both their training and legal authority under the state’s Pharmacy Practice Act ?

Since we are dealing with subjective diseases… will pharmacists be held to a higher liability when they fail to “get it right” and refuse to fill prescription(s) written by a legal prescriber ?

There was a couple of physicians in the early 90’s that got sued for refusing to treat the pain of end of life cancer pts. The survivors in the families sued … not for malpractice… but for pt/senior ABUSE.. and each lawsuit the plaintiffs were awarded ONE MILLION + for pt/senior abuse..

Normally filling a C-II prescription takes the pharmacist 2-3 times everything else because of administrative tasks that only the pharmacist can do. Asking a Pharmacist to take on the added time consuming task of “evaluating the pt’s needs” for the controlled substance could cause a lot of pharmacists to “just say no” or more commonly stated phrase “I’m not comfortable”…

But this state mandate on pharmacist could come back to haunt their employer by not providing enough staffing hours for the pharmacist to do this mandatory task(s) and/or the pt’s PBM/insurance by not providing proper funding that allows the employer to provide proper staffing.

Since we are talking about a state mandate and potential profiling, and if the board of pharmacy (BOP) can find their “balls and backbone” they should be able to act on consumer complaints of unprofessional conduct  against both the permit holder (employer) and the PIC ( Pharmacist in Charge) and the dispensing pharmacist – if not the PIC.

The primary charge of the BOP is to protect the public’s health and safety… if they fail to act on obvious and gross harm to a specific segment of the population, could those individual members of the BOP be sued for failing to “do their job” ?

Since those pts who are suffering from subjective disease… – in theory – they should be covered by the Americans with Disability Act and Civil Rights Act and if it can be proven that all involved (PBM/insurance, employers, pharmacists) put policies and procedures in place that cause profiling to happen and legit/on time/medically necessary medication was denied … which could be considered a civil rights violation of all those pts covered under those two laws.

There are so many moving parts to this whole issue…This could keep a lot of personal injury and civil rights attorneys very busy for a long time.

Filed under: General Problems