It's a lot easier to pass a law that limits patient autonomy and physician paternalism than to truly address the problem at hand, one that is due, in part, to social inequality, not to the overprescribing of pain medication. I am writing about Bill H.4056, "An Act Relative to Substance Use, Treatment, Education, and Prevention" that Governor Charlie Baker signed into law on March, 14, 2016, and that everyone is patting themselves on the back about. This Bill is applied to Schedule II-V drugs that are prescribed for a number of conditions that include pain, sleep disorders, anxiety, and depression. In other words, H. 4056 regulates prescriptions for a range of patient disorders and issues, not just opiate use; and this is where it gets a little unethical, it monitors all of these patients.
What most people take away from this bill is that it will limit the number of pain pills prescribed for a new patient. The lawmakers claim that this bill will limit the availability of prescribed drugs being sold on the streets and will reduce the number of people addicted. I will address these claims at the end of my column.
What has not been discussed openly is the "Prescription Monitoring Program," (PAP) which is a huge part of this bill. First of all, there now exists "MA Online PMP," a " secure website that can be utilized by authorized providers to retrieve the most recent twelve months' of Schedule II — V dispensed prescription histories on their patients" (retrieved from www.mass.gov/eohhs/docs/dph/quality/drugcontrol/prescriber-guide- interpreting-pmp-data.pdf). How does this jive with HIPAA and patient confidentiality? How would a patient with anxiety, for example, feel about his condition and his relationship with his doctor being available on this website? Would it increase his anxiety? I wonder.
What is the most disturbing aspect of PMP is the mandate of urine drug screens as part of an assessment plan. It is now the law, for example, that someone who suffers from depression must have his urine screened on an ongoing basis for as long as he needs medication, which could be for his entire life. Who pays for these urine tests? One had better hope that one's health insurance company does. What code do physicians put on these tests for them to be reimbursed? Who knows. But now everyone knows that you are a patient who suffers from depression.
Here are my predictions regarding this draconian bill. Patients are being asked to jump through hoops to get the medication they need. They will need to make more doctor visits. The potential for patient-physician relationships to erode is a concern. Imagine a provider who has been treating a patient for 20 years where trust has been established and now must demand urine as if their patient is in rehab. It's demeaning. It should be up to the treating physician to request or require screening, not the government.
What is going to happen is an increase in heroin use. What is going to happen are more heroin overdoses. What might also happen is an increase in suicides.
This bill is not a way to help people. It's a way to punish people. It has created a prison: in one cell are the patients whose crime is pain and suffering, and in another cell, their practitioners whose crime is caring for them. This is a bill that lumps together individuals who need prescribed drugs for various psychological/psychiatric reasons with individuals who have become addicted to opiates. That's one problem. The other problem is that this bill does not address the underlying causes of pain and suffering that can lead to addiction in the first place.
Deborah Golden Alecson is a death, dying and bereavement educator and speaker who resides in Lenox, Mass. She is the author of three books that deal with her personal loss. Learn more at www.deborahgoldenalecson.com.