Opioid laws to make it difficult to get prescription

By RILEY MURDOCK
Capital News Service

LANSING – As the opioid epidemic continues to make headlines across the country, Michigan has new laws poised to take effect that would combat addiction at the source.

The damage done by the epidemic is staggering:  2,356 people died in 2016 of drug overdoses in Michigan, according to the Department of Health and Human Services. This number eclipses the 1,064 deaths from car accidents in 2016, according to Michigan State Police.

About 115 opioid prescriptions were written for every 100 people in 2015, according to the department.

The new laws, set to take place at differing times within the year, place additional restrictions on the prescription of opioids, among other provisions.

Hospice care providers and other professionals who use opioids, however, say they’re concerned the changes will inhibit their ability to properly provide patient care.

Michael Paletta, the chief medical officer at Hospice of Michigan, said two provisions in the laws might make it more difficult to provide timely and effective hospice care.

Paletta is the hospice representative on Gov. Snyder’s Michigan Prescription Drug and Opioid Abuse Commission.

One change requires physicians prescribing opioids to be able to demonstrate they have a “bona fide provider-patient relationship.” To prescribe opioids, a doctor is required to take a patient’s medical history, examine the patient in person and draw up a plan for care.

“On the surface of it, that’s just good medical practice. No one could object to such a thing,” Paletta said.

Paletta said the requirement is intended to crack down on physicians who sit down “with a stack of prescription pads” and write scripts freely.

But, he said, “Hospice care is different.”

It’s common for hospice patients to be transferred out of hospitals without medication or prescriptions, Paletta said, and the new requirement would slow medical response for these patients after regular business hours or on weekends. On-call physicians may be unable to meet the “bona fide” standard the night they’re assigned, Paletta said.

“Normally, what we would do is, we would arrange very quickly for an opioid prescription to be filled and get the patient under control that night. The new law would prevent me from doing that,” Paletta said.

Another potential hindrance is the requirement of an electronic survey of a patient’s pharmacy activity through the Michigan Automated Prescription System. That’s intended to prevent “doctor shopping,” Paletta said, where an addict bounces among physicians to obtain multiple prescriptions without doctors’ knowledge.

That change would cause great hassle in treating terminally ill patients who often have severe pain, Paletta said, because providers would be required to run a survey for every patient, for every prescription of a controlled substance, and for hospice this would often take multiple surveys a day.

He said lawmakers are working out some kinks in the new laws. For example, one proposed revision would allow hospice providers to satisfy the “bona fide relationship” requirement through proxy — by having a hospice nurse or nurse practitioner do an assessment so an off-site physician can sign prescriptions.

A recently passed bill extended the deadline for the “bona fide relationship” rule, Paletta said, and providers are now being told they have until the end of March 2019 to comply.

Meanwhile, however, the Michigan Automated Prescription System regulations are still set to take effect on June 1, Paletta said.

Rep. Michele Hoitenga, R-Manton, said she voted against the opioid legislation because she was concerned about its impact on hospice care.

After consulting with hospice workers, Hoitenga introduced a bill to exempt hospice care providers from Michigan Automated Prescription System regulations.

“I don’t care who gets the credit. I just want to see it get done so that we’re not hurting people who are terminally ill and we’re not making barriers for the doctors who are trying to treat them,” she said.

Hoitenga’s bill is co-sponsored by Rep. Kimberly LaSata, R-Bainbridge, and Rep. Jason Wentworth, R-Clare.

Paletta acknowledged that getting exceptions might prove difficult because if hospice providers are exempted, other professions such as dentists, veterinarians and substance abuse professionals might ask, “What about us?”

“I do understand that problem,” Paletta said.

The opioid epidemic is a problem that took years to get into and will take years to get out of, Paletta said.

However, he said he’s worried that in lawmakers’ zeal to deal with the epidemic, the pendulum will swing so hard in the other direction that people with legitimate medical needs will suffer unnecessarily because they cannot get medicines they need.

“Shame on us if we allow that to happen,” Paletta said.