On Nov. 2, 2016, Gov. Wolf signed a package of legislation designed to combat the state's opioid abuse crisis into law.
"This issue is affecting far too many Pennsylvanians," said Pennsylvania Medical Society (PAMED) President Charles Cutler, MD, MACP, shortly after the bills passed the Pennsylvania legislature. "PAMED and our physician members remain committed to the well-being of our patients and will continue working to stem this crisis."
Over the course of several months, PAMED worked with physicians, legislators, and other stakeholders to help ensure that any legislation took a common sense, patient-centered approach. PAMED solicited physician feedback on the bills in order to share the Pennsylvania physician perspective with legislators.
Here's a look at four bills the governor signed that physicians and practices should be aware of:
SENATE BILL 1202
(Sponsored by Sen. Gene Yaw, R-23rd District)
The law requires that:
- For each licensure renewal period, physicians and other prescribers complete at least two hours of education in pain management, identification of addiction or the practices of prescribing or dispensing of opioids. For initial licenses, the requirement is four hours of education, with those hours being at least two hours of education in pain management or identification of addiction and at least two hours of education in the practices of prescribing or dispensing of opioids. This required training may be counted toward the 100 hours of the total CME required for biennial license renewal.
An exception: PAMED has received questions from members regarding any limitations under this exemption. PAMED has reached out to the Department of State for clarification concerning which prescribers, and under what conditions, this exemption applies. PAMED will alert its members once it receives a response. In the interim, PAMED encourages all physicians to contact the Department of State for further clarification whether the exemption applies to their particular situation.
- Dispensers query the PDMP system before dispensing an opioid drug product or a benzodiazepine prescribed to a patient under certain circumstances.
- Prescribers to query the PDMP system each time a patient is prescribed an opioid drug product or a benzodiazepine.
When does the law—now known as Act 124 of 2016—take effect?
Jan. 1, 2017.
SENATE BILL 1367
(Sponsored by Sen. Yaw)
This law will limit opioid prescriptions for minors to a seven-day duration when consent is given by a minor's parent or legal guardian, except in cases of medical emergency. There are also exceptions for cases involving chronic pain, cancer treatment, and for palliative care or hospice care. This law limits opioid prescriptions for minors to a 72-hour dose when an authorized adult, as opposed to a minor's parent or legal guardian, is available to consent for the minor patient.
Prescribers will be required to obtain written consent for the prescription from the minor's parent or guardian or from an authorized adult. The form will then be maintained in the minor's medical record with the prescriber.
When does the law—now known as Act 125 of 2016—take effect?
The law now requires state licensing boards to create the consent form that prescribers will need in order to comply with the law. When the form is available, it will be published in the Pennsylvania Bulletin, at which point the mandates of this law will take full effect.
PAMED will notify members via our website and the Dose weekly email newsletter once the form is published.
SENATE BILL 1368
(Sponsored by Sen. Tom Killion, R-9th District)
The law will establish a safe opioid prescribing and pain management curriculum in both medical colleges and other medical training facilities. SB 1398 will also allow a patient to sign a form prohibiting the prescribing or administering of a controlled substance containing an opioid to that patient.
When does the law—now known as Act 126 of 2016—take effect?
HOUSE BILL 1699
(Sponsored by Rep. Rosemary Brown, R-189th District)
This legislation will limit the prescribing of an opioid drug product to an individual seeking treatment in certain settings (an emergency department (ED) or urgent care center, or an individual who is in observation status in a hospital), to no more than a quantity sufficient to treat that individual for up to seven days. An important exception included in HB 1699 allows a health care practitioner to prescribe more than a seven-day supply to treat a patient's acute medical condition or if it is deemed necessary for the treatment of pain associated with a cancer diagnosis or for palliative care.
When does the law—now known as Act 122 of 2016—take effect?
Jan. 1, 2017.
OTHER OPIOIDS LEGISLATION CONSIDERED BY THE PA LEGISLATURE
Another bill, House Bill 1698 (Sponsored by Rep. Doyle Heffley, R-122nd District), did not win Senate approval. HB 1698 would have mandated health insurers to cover the cost of abuse deterrent opioid (ADO) analgesic drug products. While PAMED strongly supported the underlying purpose of the bill, serious concerns were expressed when a last-minute amendment was added to the legislation.
The amendment, for which PAMED expressed concern, would have directed the Department of Health to create mandatory prescribing guidelines for ADOs and requires prescribers to distribute educational materials developed by the DOH to every patient they prescribe any opioid (not just ADOs) to. That amendment would have created unnecessary obstacles for physicians and other prescribers who believe their patients may benefit from ADOs. More importantly, the educational materials would have been a "one size fits all" approach and would not have taken into account the unique clinical needs of each patient.
Pennsylvania physicians remain committed to combatting the opioid abuse crisis as well as providing care to patients who suffer from chronic pain. Physicians like James Goodyear, MD, FACS, have had the opportunity to speak with representatives from the administration and legislative staff in order to advocate on behalf of patients and physicians. Because of physician advocacy, PAMED was able to positively impact legislation for the betterment of patients.
"Although it requires additional time and effort for physicians to input patient information and utilize the system in its current iteration, the Pennsylvania Prescription Drug Monitoring Program, and its online web site PMP AWARxE, exists as an extremely valuable resource for the health of the citizens of the Commonwealth," said Dr. Goodyear. "Not only can it help physicians identify those patients who are at risk for opioid abuse and diversion, but when used in conjunction with a "warm handoff" (the process in which a person who overdoses and wants help is promptly referred by the doctor for appropriate treatment), it can actually save lives."
Access more resources on the PA PDMP at www.pamedsoc.org/database.