State Board of Medicine adopts emergency rules on opioid prescriptions

Last modified: 11/5/2015 12:44:00 AM
The state Board of Medicine has approved emergency rules for prescribing painkillers in response to the growing opioid crisis in New Hampshire, but largely rejected the changes suggested by Gov. Maggie Hassan.

During a meeting Wednesday, the board also decided to begin a more thorough review of the rules for opioid prescriptions, in hopes of hearing public input and approved a more detailed update by April.

“While the board declined to adopt the draft proposal as emergency rules, it nonetheless recognized the need for immediate change,” the group said in a press release after the meeting.

The emergency rules require prescribers to educate acute pain patients on risks of their prescriptions and how to dispose of unused pills. For chronic pain patients using opioids, the rules require a prescriber to use informed consent, a risk assessment, a written pain agreement and toxicology screening.

In addition, the emergency rules also adopt federal guidelines for best practices on prescribing opioids.

The Board of Medicine is responsible for licensing and disciplining physicians and physician assistants in New Hampshire. State officials, pointing to a link between prescription drug abuse and heroin addiction, have recently been working to crack down on the overprescribing of painkillers.

In September, Hassan wrote to the board to request specific updates to the rules. She asked to require licenses providers to undergo continuing education on pain management and prescribing opioids, limiting the emergency room to a three-day supply pain pills and requiring pain contracts, along with other safeguards. Among the examples Hassan highlighted in that letter was language used in a patient consent form that specifically says the chance of becoming addicted to pain medication is low.

“I think the rules as they are now (in the governor’s proposal) are tedious,” board member Dr. John Wheeler said. “I think there needs to be more of a differential between treating acute and chronic (pain).”

The state attorney general’s office is also investigating whether drug companies deceptively minimized the addictive risks associated with long-term use of painkillers.

While the board recognized the need for changes and did remove that form, for example, no one spoke in support of Hassan’s proposed changes. Dr. Michelle Nathan, an emergency physician at Catholic Medical Center in Manchester, said about 40 percent of the patients she sees in a shift receive a prescription for painkillers. In particular, she took issue with the governor’s recommended three-day caps on those prescriptions, calling such restrictions “highly subjective.”

“We do recognize that opiate abuse is on the rise,” she said. “We certainly are in the throes of seeing it on a daily basis. Rarely does a shift go by without seeing at least one overdose, if not several. However, we are opposed to the notion of this very rapid pushthrough of these new rules.”

Dr. Travis Harker, former president of the New Hampshire Medical Society and a family practitioner in Concord, said after the meeting he supported the board’s adjustments over the governor’s ideas. He wondered whether prescribers would have difficulty adopting the rules on such short notice, however, and why the changes couldn’t have been made with more time and public input.

“I think it would potentially have made them better and more workable,” he said.

While rule changes will address overprescribing and addiction to prescription painkillers, Harker also suggested this step is not the only one to a solution.

“I also don’t think that this is going to stop people from overdosing on heroin,” Harker said.

Hassan released a statement Wednesday evening in response to the board’s actions. Earlier in the day, the Executive Council gave Hassan the okay to seek a special session of the Legislature to address substance abuse.

“I thank the Board of Medicine and physicians for working with my office and the Department of Justice to update rules on the prescribing of opioids, and I applaud their courage in swiftly adopting important reforms, including requiring a detailed informed consent form and eliminating the reference to a statement that opioids aren’t addictive,” the statement read.

The emergency rules will take effect by the end of the week as the board notifies physicians.

(Megan Doyle can be reached at 369-3321, or on Twitter @megan_e_doyle. David Brooks can be reached at 369-3313,, or on Twitter @GraniteGeek.)


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