Board of Medicine finalizes changes to new opioid prescribing rules

Monitor staff
Published: 4/6/2016 7:50:10 PM

The New Hampshire Board of Medicine moved closer to putting stronger opioid prescribing rules in place on Wednesday.

The new rules, which come amid the state’s heroin and opioid epidemic, offer a stricter framework for doctors who prescribe opioids to patients with chronic and acute pain.

The rules would put limits on the amount of prescription pain medication doctors can prescribe to patients and require doctors to register with the state’s Prescription Drug Monitoring Program and use it.

Doctors also must complete a risk assessment, treatment plan and informed consent form for patients who request opioids. The guidelines say doctors should utilize a written agreement with their patient that says opioids can be discontinued if their use becomes problematic.

Doctor and board member John Wheeler said the board should try to strike a balance between rules that cut down on overprescribing but don’t put a blanket ban on opioids for patients who legitimately need them.

“Are doctors afraid to prescribe? I’ll be honest, we are,” he said. “We’re so much more aware.”

Wheeler said he didn’t want to make life too difficult for his fellow physicians.

“We need to be strict, but we need to be reasonable,” he said, adding that he believes one of the biggest benefits coming out of emergency rules passed last year is improved communication between physicians and patients.

Most of the rules had been hammered out at previous sessions and were being finalized at Wednesday’s meeting. Still, New Hampshire Medical Society Deputy Executive Vice President Janet Monahan said her organization had concerns with some of the language.

One rule would require random and periodic drug testing at least yearly for patients using opioids for longer than 90 days. Monahan said the Medical Society was concerned drug screenings would raise costs for patients.

Attorney General Joe Foster suggested doctors could opt to do pill counts instead of urine screenings, a cheaper option.

Foster spoke briefly at the beginning of the public hearing, asking to reinstate previously deleted language saying providers aren’t required to prescribe opioids to patients for acute and chronic pain.

“I know there’s great pressure on physicians to do so,” Foster said. “Reminding them that, I think sends a very important message.”

Foster said the rules will ask doctors to do some difficult things with patient care around pain, but it was necessary to combat the opioid and heroin epidemic ravaging the state.

In 2015, more than 400 people died of drug overdoses, and the majority of the deaths were attributed to heroin and fentanyl.

“But those fentanyl and heroin deaths are linked to prescription opioids,” Foster said, repeating an oft-cited statistic that many people addicted to heroin and fentanyl got their start on prescription pain medication.

“Opioids are an important medication, but they also are medication that can be very dangerous (and) must be carefully prescribed,” Foster said, adding he hopes these new rules will accomplish just that.

One person showed up to Wednesday’s hearing to caution board members to think of patients who need opioids for chronic pain management.

Jim Armenio of Boscawen said his wife, Lorraine, has been taking opioids for chronic pain for more than two decades. With the new rules instituted last year, Armenio said his wife’s doctors have been more wary of prescribing her pain medication.

“Doctors at this point seemed more concerned with liability than they do with treating the patients,” Armenio said, raising his voice at times.

“All Lorraine’s looking for is a well-balanced life,” he added. “She’s living in pain because of everything that’s happening at this table today. I understand what you’re doing, it’s God’s work, but it’s hurting good people, too.”

The board’s new rules don’t apply to cancer patients and terminally ill patients. Earlier in the day, state senators heard public testimony on House Bill 1423, which would require the boards of medicine, dental examiners, podiatry and veterinary medicine to adopt opioid prescribing rules.

The Board of Medicine rules will be instituted after the emergency rules lapse in early May.

(Ella Nilsen can be reached at 369-3322, or on Twitter @ella_nilsen.)

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