Bill Targets Opioids Use
By J. Todd Foster
A New Jersey lawmaker known for embracing the “recovery movement” has introduced legislation that would require all prescribers to comply with a strict protocol or receive no reimbursement for opioids.Sen. Raymond Lesniak, D-Union, said the impetus behind Senate Bill 2703 were opioid crackdowns by the workers’ compensation systems in California and Texas.
“I thought if it works for workers’ compensation claims, then why not all health insurance claims and not just injuries sustained at work?” Lesniak said Tuesday in a telephone interview. “There has been an explosion of opioids addiction and deaths from both opioids and heroin in New Jersey, and it has struck me and the people I work with in the recovery movement to take stronger action.”
Under the proposed bill, prescribers first would have to consider alternative treatments, follow updated guidelines by the Centers for Disease Control and Prevention, and counsel patients about the risks.
Doctors or nurses would have to take a patient’s medical history, conduct a physical examination and craft a pain-management plan.
Texas uses the Official Disability Guidelines crafted by the Work Loss Data Institute, and California in August tightened its medical treatment utilization schedule to include stand-alone guidelines for prescribing opioids.
Lesniak, a champion of treatment in lieu of prison for convicted addicts, is the namesake of the Raymond J. Lesniak Experience Strength Hope Recovery High School, which opened in September 2014 in Union. It is New Jersey’s first recovery high school for students with alcohol and drug addictions, and offers peer-to-peer support groups, 12-step programs and individual and family counseling.
“Everyone knows someone either in recovery or someone who didn’t recover and is suffering from it or died from it, and I as well from personal experience,” Lesniak said.
He said he expects his Senate colleagues to be supportive but is girding for battle with Assemblyman Herb Conaway Jr., a physician who is the majority whip and chairman of the Health and Senior Services Committee, a hurdle for all health-related legislation.
Conaway could not be reached for comment Tuesday.
The Partnership for a Drug-Free New Jersey and Physicians for Responsible Opioid Prescribing are solidly behind S2703. The Medical Society of New Jersey is solidly against it.
The bill reduces clinical decision-making and does not factor in each patient’s individual circumstances, such as lack of transportation, said Mishael Azam, the society’s chief operating officer and senior manager of legislative affairs.
“The irony is that insurance companies already give doctors and their patients such a hard time for covering these drugs, and many other medications and procedures,” Azam said. “And informed consent and proper medical records are already required by New Jersey law.”
New Jersey has one of the lowest opioid-prescribing rates in the country, Azam said, and it’s continuing to fall.
“Making it harder for patients in pain to get medication that gives them the ability to have a decent quality of life or perform simple daily functions is sadly and dangerously misguided,” she said. “Piling on mandates does not improve medicine or reduce illegal drug or medication abuse.”
Lesniak conceded that the number of opioid prescriptions is decreasing but added, “It doesn’t mean they can’t spike up again.”
The American Insurance Association supports S2703. An official said the group worked with the Centers for Disease Control and Prevention in developing its updated prescribing guidelines.
“The nuts and bolts of this are aimed at making sure that prescribing opioids is the correct course of treatment and also aimed at preventing addiction. When injured workers get addicted to opioids, it’s difficult if not impossible to get them back to work,” said Eric Goldberg, AIA vice president of state affairs for the Mid-Atlantic region.
The Partnership for a Drug-Free New Jersey says Lesniak’s bill is the first of its kind in the country, in that it targets all opioid prescriptions.
“We have to educate family members, young people, seniors and the medical community who are on the front lines of the epidemic. The only way to do that is if everyone takes responsibility,” said partnership Executive Director Angelo Valente.
“In New Jersey, two families a day lose a loved one to the opioids and heroin epidemic,” he said.
Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, said he hopes other states will follow New Jersey’s lead and pass similar legislation.
“This will help prevent addictions, and it will help improve care of patients with pain,” he said. “It gets to the heart of the problem we’re facing in the U.S., which is overprescribing. I think it’s a very smart deal.”
S2703 would require prescribers to document that non-opioid medications and alternative therapies failed, that they have consulted the state’s Prescription Monitoring Program, and that they have counseled their patients.
Prescriptions of fewer than four-day supplies of opioids are exempt from the legislation, as are patients receiving palliative or hospice care and not more than 90 milligrams of morphine-equivalent doses per day.
Lesniak’s proposed legislation follows S2156, which passed the Senate 35-1 last week and now resides with the Assembly Health and Senior Services Committee.
That bill, sponsored by Democratic Sens. Loretta Weinberg and Joseph F. Vitale, would require doctors and dentists to counsel minors under 18 about addiction dangers before prescribing them any Schedule II controlled substances or opioids.
“The prescriber will specifically be required to discuss the risks of developing a physical or psychological dependence on the medication and, if the prescriber deems it appropriate, any alternative treatments that may be available,” S2156 states.
Prescribers also must obtain written acknowledgement of the discussion by using a form to be developed by the Division of Consumer Affairs and including that form in the patient’s medical file.
Joseph Pennacchio, a retired dentist, was the only senator who voted against S2156.
“I think it’s an overburden on the medical and dental communities,” Pennacchio said by phone. “We always counsel patients on medicine. This would open up the medical and dental communities to liability. They already spend more time on paperwork and covering themselves from malpractice and regulation as opposed to what’s actually ailing the patient.”
