Terrifying legislative development in my neck of the woods...

[EtherBunny]

Here's the meat of a new bill going through the Georgia senate right now. Although I routinely check the PDMP, I still find this bill absolutely terrifying. What the hell is going on????

SECTION 2-5: Requires a physician to review the PDMP whenever prescribing a Schedule II, III, IV, and V controlled substances for the first time and every day thereafter. The exception to checking the PDMP initially is limited to 3 day prescriptions. When prescribing a Schedule II, III, IV, and V for the first time, a physician may not prescribe more than a 5-day supply for adults and may not prescribe more than a 5-day supply to a minor ever. A physician may exceed the 5-day restriction if he/she believes it is medically necessary for palliative care or to treat a patient's acute medical condition, chronic pain, or pain associated with a cancer diagnosis. This section does NOT apply to controlled substances used specifically for the treatment of abuse or dependence on a Schedule II, III, IV, or V controlled substance.


SECTION 2-6: Any prescriber who knowingly or intentionally fails to review the PDMP or knowingly and intentionally disregards the prescription information in the PDMP shall be guilty of a felony. The possible penalties are a $50,000 fine and/or imprisonment of one to five years.

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[ampaphb]

" ... and every day thereafter ... " WTF?

Sent from my SAMSUNG-SM-G920A using SDN mobile

 

[Ligament]

SECTION 2-6: Any prescriber who knowingly or intentionally fails to review the PDMP or knowingly and intentionally disregards the prescription information in the PDMP shall be guilty of a felony. The possible penalties are a $50,000 fine and/or imprisonment of one to five years.

Ok, I don't check a PDMP once and I spend 1-5 years in jail???

 

[101N]

And here is why, it works.

Mandatory Provider Review And Pain Clinic Laws Reduce The Amounts Of Opioids Prescribed And Overdose Death Rates

1. Deborah Dowell1,*,
2. Kun Zhang2,
3. Rita K. Noonan3 and
4. Jason M. Hockenberry4

+Author Affiliations

1. [email protected]) is a senior medical advisor at the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia.
2. ↵*Corresponding author

Abstract
To address the opioid overdose epidemic in the United States, states have implemented policies to reduce inappropriate opioid prescribing. These policies could affect the coincident heroin overdose epidemic by either driving the substitution of heroin for opioids or reducing simultaneous use of both substances. We used IMS Health’s National Prescription Audit and government mortality data to examine the effect of these policies on opioid prescribing and on prescription opioid and heroin overdose death rates in the United States during 2006–13. The analysis revealed that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent. We also observed relatively large but statistically insignificant reductions in heroin overdose death rates after implementation of these policies. This combination of policies was effective, but broader approaches to address these coincident epidemics are needed.

 

[Aether2000]

I would think every day after would be every time a prescription is written.

 

[VA Hopeful Dr]

South Carolina has regulations like that for Medicaid patients already. Don't check the database, you don't get paid for the visit if controlled substances are involved.

You know what happens? Medicaid patients don't get controlled drugs because its now a pain in the butt to prescribe them.

 

[willabeast]

no way every day. probably a typo. maybe call the local DA and document the conversation.

 

[Aether2000]

Given the much higher statistical likelihood of substance abuse occurring in the Medicaid population, it appears the Virginia program is working superbly

 

[lobelsteve]

I am looking into this and we'll try and give you a feel for how it will pan out. There is usually lots of time to make adjustments in the language of a bill

 

[clubdeac]

Maybe it's every day just for those 5 days the patient is receiving the med if it's a small script. Either way that's ridiculous

 

[drusso]

Here's the meat of a new bill going through the Georgia senate right now. Although I routinely check the PDMP, I still find this bill absolutely terrifying. What the hell is going on????

SECTION 2-5: Requires a physician to review the PDMP whenever prescribing a Schedule II, III, IV, and V controlled substances for the first time and every day thereafter. The exception to checking the PDMP initially is limited to 3 day prescriptions. When prescribing a Schedule II, III, IV, and V for the first time, a physician may not prescribe more than a 5-day supply for adults and may not prescribe more than a 5-day supply to a minor ever. A physician may exceed the 5-day restriction if he/she believes it is medically necessary for palliative care or to treat a patient's acute medical condition, chronic pain, or pain associated with a cancer diagnosis. This section does NOT apply to controlled substances used specifically for the treatment of abuse or dependence on a Schedule II, III, IV, or V controlled substance.


SECTION 2-6: Any prescriber who knowingly or intentionally fails to review the PDMP or knowingly and intentionally disregards the prescription information in the PDMP shall be guilty of a felony. The possible penalties are a $50,000 fine and/or imprisonment of one to five years.

I'm excited to see the increased reimbursement and funding that supports this activity!

 

[bedrock]

South Carolina has regulations like that for Medicaid patients already. Don't check the database, you don't get paid for the visit if controlled substances are involved.

You know what happens? Medicaid patients don't get controlled drugs because its now a pain in the butt to prescribe them.

Anything that reduces opioid scripts for Medicaid patients is a likely a good thing, as 95% of them shouldn't get them anyway.

 

[knoxdoc]

Adios Lyrica.

 

[SeniorWrangler]

We are slowly but surely moving towards a "prescribe Vicodin, go to jail" policy.

 

[lobelsteve]

Controversy flares over Senate bill to curb opioid epidemic
Doctors would be required to register with state database.

ByAriel Hart [email protected]

A bill aimed at curbing opioidaddictionnarrowlypassed a Georgia Senate committee Thursday, after tense words over its attempt to make doctors criminally liable for not tracking prescriptions.

The legislation is a leading part of a multi-pronged initiative by state Senate leaders this year to strengthen laws against opioid misuse and mental health services for those in its grip.

Senate Bill 81, which passed seven votes to six, would require doctors who prescribe drugs like opiates and benzodiazepines to register with a state database that tracks patient prescriptions. They’d have six months to get up to speed using it, learning to research whether their own patients were doctor-hopping or getting too many prescriptions for addictive drugs.

Then starting in July 2018, if they “knowingly and intentionally” don’t use the database or ignore the information in it, they could be guilty of a crime. If the doctor’s staff member was “delegated” to use the database and intentionally didn’t, then that staffer would be on the hook. Certain doctors would be exempt, like those in palliative care.

Doctors protested that making it a crime went overboard. The legislation’s sponsor disagreed.

“You have to remember we’re dealing with professionals who’ve been to school for a long time,” said Sen. Renee Unterman, sponsor of the bill and chairwoman of the Health and Human Services committee, which heard the bill. “What I’m trying to do is get on the front end, ahead of the curve to save lives.”

Georgia, like other areas of the country, has been in the grip of an opioid epidemic that has led to thousands of overdose deaths. In 2015 alone, 7.8 million pain medication prescriptions were issued here, equivalent to more than one prescription for every Georgia adult, a joint investigation by the Associated Press and the Center for Public Integrity showed.

In the past, doctors who over-prescribed or patients who went from doctor to doctor looking for easy prescribers were found out only after a death or overdose. Unterman, R-Buford, hopes that increasing mandatory use of the database will speed up detection of over-prescribing.

Pharmacists already use the database, and she called that a backstop. No pharmacist has yet been prosecuted under that law, said Greg Rey-bold, a lobbyist for the Georgia Pharmacy Association.

Sen. Ben Watson, a Savannah Republican and internal medicine doctor, voted against the bill. He said he supported the desire to deal with opioid misuse. But he raised the specter of a doctor making a prescription in a crisis situation and forgetting to use the database, and then getting hit with a misdemeanor.

With a misdemeanor conviction, “I lose my hospital privileges,” up-ending a career, he said. “If you make a mistake, it should be referred to the board.”

The Georgia Composite Medical Board, which oversees doctors, is made up mostly of other doctors and has jurisdiction over careers, not crimes. Watson said existing criminal laws were adequate to deal with doctors who use their prescribing privileges to deal drugs.

Unterman was blunt with reporters after the hearing in her criticism of the doctors’ opposition.

“I’m addressing the opioid epidemic,” she said. “Unfortunately the doctors would like to make it all about them.”

The bill now goes to the Senate floor.

 

[Aether2000]

Easy solution: stop prescribing controlled substances to everyone across the state, telling patients that the legislature has criminalized the prescribing of opioids and benzodiazepines.

 

[DrCommonSense]

Here's the meat of a new bill going through the Georgia senate right now. Although I routinely check the PDMP, I still find this bill absolutely terrifying. What the hell is going on????

SECTION 2-5: Requires a physician to review the PDMP whenever prescribing a Schedule II, III, IV, and V controlled substances for the first time and every day thereafter. The exception to checking the PDMP initially is limited to 3 day prescriptions. When prescribing a Schedule II, III, IV, and V for the first time, a physician may not prescribe more than a 5-day supply for adults and may not prescribe more than a 5-day supply to a minor ever. A physician may exceed the 5-day restriction if he/she believes it is medically necessary for palliative care or to treat a patient's acute medical condition, chronic pain, or pain associated with a cancer diagnosis. This section does NOT apply to controlled substances used specifically for the treatment of abuse or dependence on a Schedule II, III, IV, or V controlled substance.


SECTION 2-6: Any prescriber who knowingly or intentionally fails to review the PDMP or knowingly and intentionally disregards the prescription information in the PDMP shall be guilty of a felony. The possible penalties are a $50,000 fine and/or imprisonment of one to five years.

I believe the FELONY charge is ridiculous, however, I think legislation causing providers to be forced to watch PDMP and UDS is important. I suspect they will change the FELONY part to just possibly getting in trouble with the medical board if it continues.

You don't realize how many PCPs send over opioid patients (particularly Medicaid) that have been clearly shopping around with multiple providers.

Too many providers have been very sloppy with even doing a rudimentary check of PDMP systems (or equivalents) or even consistent UDS testing on patients who are clearly very high risk and just want "higher and higher" dosages of medications/lose medications/etc despite being younger with minimal pathology.

Usually I have to be the "bad guy" who basically cuts these patients off medications.

These patients just shop around again or go onto heroin on the streets. Either way, these patients never become productive and were NOT productive before ever seeing a physician due to abuse of multiple illicit drugs during their younger years.

I don't believe the PCP created this problem since the patient already is an addict/mental case before ever seeing a doctor (used coke at parties during HS, partied with heroin, THC everyday, on multiple andidepressants, have previous psych pathology, etc) but these PCPs dont seem to have enough common sense to see the problem in these patients and dont even monitor them.

I only blame the physician for not monitoring the patients or realizing they are very high risk initially but never blame them for "creating an addict" like some of these liberals who want to blame docs or someone else for a personal problem. Unless the doc was truly running a "pill mill" writing Oxycontin for cash with zero diagnosis, the docs are just mostly naive/bullied by these patients.

Reminds me of the cops in Chicago.

 

[Tapspatellas]

It won't change much for good pain physicians, most already do this. There wouldn't be many PCP's left in my area...

Still this is governental intrusion into medicine. Should be the job of the board, not the state. Looking at the worst case scenario, I see some poor physician losing their license for not checking the PDMP when a patient calls in for a refill of Lyrica.

 

[EtherBunny]

Lovely. What's the likelihood of this bill becoming law?

 

[lobelsteve]

Lovely. What's the likelihood of this bill becoming law?

Unlikely in current form. Look for clause regarding knowingly did not check with high likelihood of diversion occurring. Or similar vague language to allow DA, court to decide.