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Editorial: A strong stance on opioid prescriptions

  • Toby Talbot


Friday, July 01, 2016

A footnote in a letter from Gov. Maggie Hassan last September to the state Board of Medicine pointed to a “glaring example” of the outdated guidelines doctors were using when prescribing controlled drugs. The state’s opioid crisis is fueled in part by overuse and abuse of these addictive prescribed painkillers, the governor wrote, but the guidelines are “mere recommendations” that by their own admission are even “weak” in some parts. She cited “concerning language” in a patient consent form:

“I am aware that the chance of becoming addicted to my pain medication is very low.”

We venture a sales rep for a drug company, like the ones now under investigation by Attorney General Joe Foster, could have written that line. “If this statement was ever accurate and appropriate, it is clearly not acceptable today,” the governor wrote, urging the board to work “with all due speed” to adopt stronger, more explicit, mandatory rules for prescribing opioids.

She and Foster politely offered their help in crafting new rules – and they wanted them done in about a month. They ignited an uproar, which seemed clearly intended to get a reaction – and some action – out of the medical community and the legislature. Which it did.

We applaud their effort and their resolve. The result will be good for New Hampshire citizens, and for the medical community.

Faced with a public health crisis and wary of bureaucratic slowdowns, Hassan and Foster made some suggestions for some tough changes and emergency rules for prescribing opioids.

As Ella Nilsen reported in the Sunday Monitor, doctors loudly protested that the issue was moving too fast; that the rules intruded on their clinical judgment and would needlessly bog their busy practices. The Board of Medicine rejected Hassan’s ideas – no surprise – and adopted its own set of updated rules.

Hassan and Foster, to their credit, stood their ground. Soon, HB 1423, setting mandatory standards for prescribing opioids, began to move through the state house, with bipartisan support.

The good news is that when the dust settled, the Board of Medicine, the Medical Society, and others, worked closely, and productively, with Rep. Cindy Rosenwald, a Nashua Democrat and the bill’s lead sponsor, as well as with lawmakers on both sides of the aisle. A reasonable compromise was negotiated to get some opioids off the street and out of medicine cabinets, as one doctor put it, without jeopardizing the legitimate needs of patients in pain. Hassan signed the bill into law earlier this month. The mandatory new rules go into effect Sept. 1.

Some of the new prescription rules seem like best practices in any physician’s office – patient histories, exams and risk assessments. But a key provision in the bill recognized the expert judgment of medical professionals – not politicians – in setting a cap on opioid prescriptions written in emergency rooms and urgent care centers – where patients rarely return for follow up visits.

The new rules, and added requirements, may lead some doctors to simply stop prescribing opioids. Other doctors will see the rules as a convenient way to cut short arguments with patients who demand powerful painkillers, but don’t need them. Everyone hopes that more conservative practices, and tighter rules will cut down on the quantity of painkillers out there in circulation, and subject to abuse, and theft.

It may stop some patients from becoming new addicts. We think doctors and dentists and other prescribers will now be more cautious about prescribing heavy duty pain killers when something else – and maybe a little discomfort – will do.