Officials target opioid prescriptions

http://www.unionleader.com/Officials-target-opioid-prescriptions

Gov. Maggie Hassan and Attorney General Joseph Foster went behind closed doors last week with state medical officials to present a draft of tough rules for doctors who prescribe opioids, the New Hampshire Union Leader has learned.
Hassan has asked the Board of Medicine to use emergency powers to adopt the rules, which would short-circuit the normal public input process used when state agencies adopt rules. Hassan’s office provided a copy of the rules, which have not been made public, to the Union Leader when requested.
The New Hampshire Medical Society said dozens of physicians have asked that the process be slowed down and proceed through the normal process.

“This is a very serious and complex problem, and it will affect patients,” said Janet Monahan, executive vice president of the 2,200-member Medical Society. “Not every patient that receives an opioid is an addict.”
Monahan said the opioid task force, which is part of the Governor’s Commission for Alcohol and Drug Abuse Prevention, Treatment and Recovery, opposes the emergency implementation.

“We’re not against the rules,” Monahan said, “but let’s have an open process and not rush it.”
Hassan’s spokesman said the emergency rules are only valid for six months, which gives time for the formal adoption to proceed.

“We’re in the middle of a crisis,” said Hassan spokesman William Hinkle. “This is about saving lives. This is a crisis situation.”
The draft rules take up 12 pages. A copy is available by clicking here.

• They require any doctor or nurse practitioner who prescribes opioids to have continuing medical education.

• Any opioid prescription would have to follow a documented evaluation that would include a patient’s pain intensity, previous pain treatments, history of addiction, family history and social assessments.
• Opioids could only be prescribed when other pain-management efforts have not worked and the benefits outweigh the risks. Supplies would be limited to five days for episodic patients and fentanyl could not be supplied to non-cancer patients.
• A prescriber must use the state-controlled drug database to review a patient’s drug history before writing a prescription. Prescriptions for chronic pain could only be written in multiples of a seven-day supply.
• A doctor must discuss the risks with his or her patient.

• Patients at high risk for addiction must sign a written agreement that includes permission for blood or urine tests, reasons for discontinuation and an agreement not to abuse alcohol or other drugs while on the medication.
Hinkle said the draft rules are a starting point, and his office is accepting input from physicians and other interested parties.

He said once the rules are presented to the board in public, the board can adopt them under emergency provisions.
“The timeline hasn’t been finalized,” he said.

Hinkle would not confirm that a meeting with the Board of Medicine is scheduled for Oct. 28. According to the Board’s website, its next regular meeting is Nov. 4.
Earlier Thursday, questions arose about how much contact Hassan’s drug czar, Jack Wozmak, has had with the N.H. Medical Society and other physicians.

New Hampshire Medical Society President Dr. Lukas Kolm said Wozmak has met with individual members, but not the society’s leadership group as a whole.
“To bring everybody together, that is what I have not seen,” said Kolm, an emergency room physician in Dover. He added that he doesn’t want the process driven by politics.

Hinkle responded by saying that the medical community has given some resistance to the rules.
Republican Party Chairman Jennifer Horn faulted Hassan for not working more closely with doctor groups and said it’s another sign of Hassan’s mismanagement and incompetence when it comes to dealing with the opioid epidemic.
“These doctors are on the front lines of combating New Hampshire’s heroin epidemic, and they deserve the full support of the governor’s office,” Horn said.

mhayward@unionleader.com