OP-ED: Legislation could hurt efforts to reverse opioids crisis
The Pennsylvania Legislature has introduced 17 bills this session aimed at curbing the opioid epidemic. While some new laws resulting from this flurry of legislation appear to be making a difference, the passage of Senate Bill 655 could have dire consequences for patients.
SB 655 passed the Senate and is awaiting a vote in the House Health Committee. If enacted, it would mandate that physicians like myself follow clinical guidelines when prescribing opioids.
This concerns me, and many other physicians, for several reasons.
First, medicine is not an exact science. Every patient is different, and a treatment protocol that may be effective for one patient may not be effective for another.
By mandating “one-size-fits-all” medicine through SB 655, the Legislature is essentially taking the decision-making out of the hands of highly trained medical professionals.
A second concern with SB 655 is that guidelines change as the science behind medicine changes, and physicians need the flexibility to change with it. In the four years since Pennsylvania’s current voluntary opioid prescribing guidelines debuted, two of the 10 guidelines have been updated and another two are in the process of being updated.
Changing these current voluntary guidelines to keep up with advances in medical knowledge now takes a relatively brief time. If guidelines become law, updating them could take years.
One example is how physicians treat pregnant women who suffer from substance use disorder.
When we started writing Pennsylvania’s voluntary guidelines for obstetrics and gynecology, the use of buprenorphine was not considered safe. By the time these guidelines were finished, buprenorphine had been reported as not only safe but decreased the incidence of Neonatal Abstinence Syndrome.
This information was so new that the Pennsylvania Board of Medicine objected to including it in the guidelines until we provided data from the American Congress of Obstetricians and Gynecologists to support it.
If the guidelines had been published six months earlier, the use of buprenorphine would not have been included.
As you can see, passage of SB 655 would eventually saddle physicians with a “no-win” decision: follow the mandated guidelines knowing it’s potentially not the best course of treatment for their patient or break the law in the interest of appropriate patient care.
We urge the Pennsylvania House of Representatives to oppose SB 655, and instead focus on a more immediate need in this crisis: increasing access for those who need treatment for opioid use disorder.
Like our elected lawmakers, physicians desperately want to contribute to eradicating this epidemic.
Through physician groups like the Pennsylvania Medical Society, we have worked with the Legislature and state agencies to support measures that cut the number of opioid prescriptions by 1.3 million in 2017. That was the second highest percentage decline in the nation.
Some of these effective actions have included: expanding of the prescription drug monitoring program; increasing education for physicians, and creating the voluntary prescribing guidelines.
I encourage our lawmakers to continue seeking common-sense solutions to this crisis. But putting guidelines into statute and mandating “one-size-fits-all” medicine sets a dangerous precedent.
That, sadly, is what SB 655 would do.
Dr. John Gallagher is chairman of the Pennsylvania Medical Society’s Opioid Advisory Task Force. He is a physician from Sharon who specializes in obstetrics and gynecology.