Legal and Legislative News

The Centers for Disease Control and Prevention (CDC) has released proposed guidelines for prescribing opioids for chronic pain. The Montana Medical Association is gathering comments on the guidelines from physician members to potentially submit feedback before the public comment period ends on Jan. 13 2016. The MMA is requesting members submit their comments to Jean Branscum at [email protected] by Monday, January 11th.

CDC Proposed Opioid Prescribing Guidelines

AMA Letter to CDC on Opioid Guidelines

In an email that went out the CDC offered this comment, “CDC is developing an opioid prescribing guideline to help primary care providers offer safer, more effective care for patients with chronic pain and help reduce misuse, abuse, and overdose from these drugs. The guideline will provide recommendations to primary care providers about the appropriate prescribing of opioid pain medications to improve pain management and patient safety. Recommendations focus on the use of opioids in treating chronic pain (i.e., pain lasting longer than three months or past the time of normal tissue healing). The guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.”

Public comments for docket #CDC-2015-0112 can be voiced here.

The Montana Medical Association is supporting three bills that would help address prescription drug abuse and diversion in Montana. The MMA worked with the Children, Families, Health & Human Services Interim Committee to come up with the three bills. The three pieces of legislation – Senate Bill 7, Senate Bill 8 and Senate Bill 9 – all are being sponsored by Senator Roger Webb of Billings.

Below are overviews of each bill and where they currently stand in the legislative process.

Senate Bill 7 (Revise and extend the prescription drug registry fee) SB 7 by Senator Roger Webb of Billings would extend the sunset for the Prescription Drug Registry and raise the fee from $15 to $30. William Gallea, M.D., noted in testimony the MMA would like to see the increased fee help pay for future enhancements, which include delegating access to support staff, the ability to share information with other states, having data available in real time and having the ability to provide feedback to prescribers. Status: Passed Senate and heard in House Human Services Committee on Jan. 23, 2015. MMA POSITION – SUPPORT

Senate Bill 8 (Allow electronic prescribing of controlled substances prescriptions) SB 8 by Senator Webb would allow for the electronic prescribing of controlled substances. Montana is the last state to adopt such a law. It will assist in making additional gains in curbing prescription drug abuse and diversion, and reducing deaths due to prescription drug abuse. Status: Passed Senate and heard in House Human Services Committee on Jan. 26, 2015.  MMA POSITION – SUPPORT

Senate Bill 9 (Allow sharing of certain health care information with law enforcement) SB 9 by Senator Webb clarifies and allows for health care providers to be able to share certain information with law enforcement, and provides immunity to providers. This bill is viewed as a tool to address doctor shopping and in making additional gains in curbing prescription drug abuse and diversion, and reducing deaths due to prescription drug abuse. Status: Failed third reading on Senate Floor on Feb. 23, 2015. MMA POSITION – SUPPORT

Montana Legislative Services – September, 2014

The 2013 Legislature approved Senate Joint Resolution 20 for a study of ways to reduce prescription drug abuse. Legislators ranked the study seventh out of 17 study resolutions in a post-session poll, and the Legislative Council assigned the study to the Children and Families Committee. The committee reviewed and adopted a study plan at its meeting on June 25, 2014.

During its study, the committee heard from medical professionals about pain management and the use of prescription narcotics; from law enforcement officials who investigate and prosecute cases involving prescription drugs; and from national experts who have studied prescription drug abuse and ways to prevent it, including the use of prescription drug monitoring programs as a preventive tool. Members also heard from Montana state agencies about steps they are taking to reduce prescription drug use, misuse, and abuse.

The committee considered five study-related bill drafts during the interim and approved three of them for introduction in the 2015 Legislature. The bills would:

• extend the sunset date for the fee that certain health care providers pay for the Montana Prescription Drug Registry, from 2015 to 2017, and allow the fee to be increased from the current $15 to a maximum of $30;
• allow health care providers to submit prescriptions for controlled substances to pharmacies using electronic means; and
• clarify that health care professionals may notify law enforcement when they believe patients are illegally obtaining prescription painkillers or may cause an imminent threat to public health or safety. The bill also would provide immunity to providers who share the information.

The committee also considered draft legislation to require health care licensing boards to adopt uniform pain management rules for the use of opioids in treating chronic, non-cancer pain and to require an adult to pick up a controlled substances prescription for a minor. Based on public comment received on those drafts, the committee decided against introducing the legislation in the 2015 session.

To see all of the draft legislation and reports, please click here.

Overview of the Issue

In early 2013, the MMA began discussions on the public health crisis of opioid abuse, misuse and diversion with a focus on what the Association might do to assist physicians to become more knowledgeable of the changing best medical practices when treating patients with chronic pain, and encourage cooperation with local law enforcement officials on concerns of possible diversion.

Later that year, the MMA determined the topic demanded the creation of a work group that would bring together physicians with expertise in this area, physicians engaged in practice changes to address the issue and other stakeholders. The MMA Committee on Prescription Drug Abuse was officially launched in January 2014 with nearly 20 physician members and has since met on a regular basis to share for hours their expertise, which laid the groundwork for a framework as described below.

Statistics caught the attention of physicians and those physicians working to address this issue specifically set an overarching goal to decrease the number of overdose deaths in Montana. Statistics from the Centers for Disease Control & Prevention (CDC) note that enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for one month. Approximately, three out of every four pharmaceutical overdose deaths in 2010 were due to opioid analgesics like oxycodone, hydrocodone and methadone. Medicaid patients are prescribed painkillers at twice the rate of non-Medicaid patients and are at six times the risk of prescription painkiller overdose. And unintentional overdose deaths related to prescription opioids have quadrupled since 1999—and now outnumber those from heroin and cocaine combined. It has been further noted that within the world of workers’ compensation, there is significant proof that long-term opioid use leads to longer claim duration, longer-term disability, higher costs and higher medical expenses.

Clearly, this issue is deserving of a statewide, multi-stakeholder approach as it reaches beyond the physician office doorway. The consequences impact our families and friends, the communities we live in and our workplaces. The issue needs to be tackled from both a supply-side and demand-side, and strategies must grow from a framework directed at health care providers, patients, law enforcement and the general public. The MMA has expanded its work group to include other stakeholders and offers the below framework to describe how best to engage physicians and to offer action steps to start addressing the issue.

The MMA will move forward to ensure physicians are aware of educational training opportunities and strongly promote all physicians make the effort to be knowledgeable of current best medical practices in treating pain, create tools to assist physicians care for their patients and make available resources. We believe the call to action is now and have developed the attached timeline to keep us focused.

The MMA advocates for the state of Montana to support efforts to address the prescription drug abuse issue by being an active partner to pass legislation and provide funding, including establishing convenient, permanent drop-off bins for prescription drugs; providing funding to educate providers, patients and providers; offering legislation that clarifies current law related to the sharing of information by physicians with law enforcement and providing immunity; identifying stable funding sources for the Prescription Drug Registry; allowing electronic prescribing for controlled substances; and supporting proposals that can reduce the demand by offering treatment options for those suffering from prescription drug abuse.