Rep. Mitch Greenlick of Portland, and his fellow Democrat, Attorney General Ellen Rosenblum, ran into traffic on Wednesday at a public hearing on their proposal to enact criminal penalties on physicians who improperly prescribe narcotic medications.
House Bill 2114 limits a doctor’s ability to prescribe highly addictive opiate medications to a seven-day dosage for an initial prescription, while laying out a wide range of exceptions, which would require the doctor to document the need. If they don’t comply, they could be charged with a Class A misdemeanor.
The bill immediately stirred objections from the Oregon Medical Association, Providence Health & Services and patient advocates as a bridge too far to combat the opioid epidemic, which was created by the massive over-prescription of narcotic medications pushed by corporate pharmaceutical companies.
Rosenblum said enough prescription narcotics were dispensed in Oregon each year to give every resident their own bottle.
In 2015, opioids killed more than 33,000 people in the United States, as well as beloved musical icon Prince last year, who acquired his addiction the way many regular Americans have -- after undergoing hip surgery. According to the U.S. Department of Health and Human Services, emergency room visits for opioids increased 114 percent between 2004 and 2011. Oregon’s rate of emergency visits exceeds the national rate.
“Even when used as directed, the risk of overdose and addiction is serious. In less than two decades, the number of opioid prescriptions written each year has quadrupled, yet the amount of pain reported by Americans has not changed,” Rosenblum testified. “Opioids are now the most commonly prescribed class of medications in the United States, and almost two million Americans suffer from prescription opioid addiction.”
Rosenblum and Greenlick introduced the legislation, hoping it would reduce both the supply and demand fueling the epidemic, by reducing the number of pills entering the public and reducing the number of people who become addicted after recovering from injury or surgery. “2114 is a really simple bill. It will take a little step in dealing with the opioid problem,” Greenlick said. “It will make it a little easier to put the problem under control.”
The Centers of Disease Control recommends just a seven-day supply -- which the Oregon Medical Association said was also their guideline -- but pushed back at a possible criminal statute for doctors who do not follow the guideline. They were also opposed to codifying a guideline into state law.
“We do not believe criminalizing prescription writing achieves better patient care,” argued Mark Bonanno, a medical association attorney. “In fact, if practitioners fear prosecution for writing prescriptions for opioids or opiates, we expect the pendulum for the public health issue of properly treating pain will swing all the way back to under-treatment of pain.”
His colleague, Dr. Andris Antoniskis, asked instead that the House Health Committee scrap HB 2114 in favor of a public endorsement of a set of guidelines he helped craft with the Oregon Health Authority.
The new guidelines recommend first seeking non-opioid approaches to pain treatment, minimizing narcotic use when they are prescribed, and using immediate-release drugs for chronic pain. The guidelines also suggest using marijuana as an alternative medicine.
“There are many patients who require ongoing medication who do not have an addiction or dependency,” said B.J. Cavnor, the director of 1-in-4 Chronic Health, a patient advocacy group that receives funding from pharmaceutical companies. “Pain should be managed by primary care doctors and chronic pain management.”
Providence’s opposition was more limited -- lobbyist Jessica Adamson simply wanted an amendment that protected pharmacists from criminal liability if they dispensed larger supplies of narcotics in accordance with a physician’s prescription.
Rep. Knute Buehler, R-Bend, an orthopedic surgeon, echoed the sentiments of the Oregon Medical Association in cautioning against dictating the practice of medicine through legislation, and opening up physicians to civil and perhaps criminal liability for not following the strict statutes.
But Greenlick said physicians were already liable to lose their medical license for abusive prescribing practices. Rep. Cedric Hayden, R-Cottage Grove, a dentist, said the bill provided for exceptions to the seven-day limit that cover the gamut of possible conditions, including acute pain, chronic pain, cancer and palliative care.
Rosenblum compared the criminal exposure for excessive opiate prescribing to the state’s Death with Dignity Law, where physicians are severely limited in their ability to give patients the medications that would end their lives.
Chris can be reached at [email protected].
