July 2017 Update – What does House Bill 159 mean?

This month we’re devoting the news column to a question we’ve heard a lot about these past two months – what does House Bill 159 mean?  While attempting to maintain neutrality on the subject to the extent possible in this column, and just relay the facts as they have been signed into law this month, we will go so far as to say that changes to “business as usual” are long overdue.

First of all, a little background is in order.  The United States is squarely in the middle of a crisis of drug dependence and abuse, and most people are aware by now that more people die from drug poisoning in this country than automobile accidents.  Drugs/medications are now the number one cause of accidental death in this nation.  Over 50,000 people died last year from opioids in the U.S., and 70 Alaskans have already died from opioid overdose in the first half of this year.  The problem is real, and is growing.

HB159 aims to help remediate what expert physician and public policymaker panels have stated by consensus is out-of-control opioid prescription at the root of the epidemic.

In the introductory words of the bill: “The United States Centers for Disease Control and Prevention guidelines state that a three-day initial prescription of an opioid is sufficient for most cases of acute pain… the likelihood of a person’s chronic opioid use increases with each additional day of medication supplied after the second day.”  The new law accordingly limits new opioid prescriptions to a 7-day period, unless “in the professional judgment of the licensee, more than a seven-day supply of an opioid is necessary for (1) the patient’s chronic pain management; the licensee may write a prescription for an opioid for the quantity needed to treat the patient’s medical condition or chronic pain; the licensee shall document in the patient’s medical record the condition triggering the prescription of an opioid in a quantity that exceeds a seven-day supply and indicate that a nonopioid alternative was not appropriate to address the medical condition; or (2) a patient who is unable to access a practitioner within the time necessary for a refill of the seven-day supply because of a logistical or travel barrier; the licensee may write a prescription for an opioid for the quantity needed to treat the patient for the time that the patient is unable to access a practitioner; the licensee shall document in the patient’s medical record the reason for the prescription of an opioid in a quantity that exceeds a seven-day supply and indicate that a nonopioid alternative was not appropriate to address the medical condition;”

HB159 also requires ongoing pain management education including opioid prescription education for maintenance of medical licensure, and another recent bill more well known to practitioners (SB79) has mandated that with a few exceptions (including prescriptions lasting three days or less) prescribers are now legally required to check the State’s Prescription Drug Monitoring Program database on individuals to whom they are prescribing opioids (or any Schedule II or III substance.)

Many people are affronted by the perception that the government is “interfering with medicine.”  This has, and will almost certainly continue to be argued in courts around the land, but the fact is that the prescription of controlled substances of all types (including but not limited to opioids) is a matter of both individual and public safety, governed by those we elect, just as is traffic or firearm safety, or national defense.  Anyone unfamiliar with the Opium Wars of the 1800s, whereby the British Empire in essence decimated the Chinese Qing Empire after rendering them addicted to Bengal opium should read up on this dark chapter of English history and consider the modern parallel.