Doctors do not always take kindly to lawmakers passing bills that could encroach on their medical decisions.
In the case of the Pennsylvania opioid crisis, Dr. Jack Kabazie, director of Allegheny Health Network’s division of pain medicine, is willing to make an exception.
“Personally, I hate to have the Legislature tell us how we have to practice medicine,” Kabazie said Thursday in reaction to a package of bills addressing the opioid epidemic. “That being said, we as doctors haven’t done a very good job of policing ourselves. It unfortunately has come to this.”
State lawmakers sent to Gov. Tom Wolf for signature this week bills aimed at fighting addiction to potent prescription painkillers. The bills would limit the opioid quantities prescribed to emergency room patients to seven days, except in specified situations; limit the opioid quantities prescribed to minors to seven days, except in certain situations; and require prescribers to review the state’s prescription drug monitoring database each time they prescribe opioids. Medical colleges would be required to establish a safe opioid prescribing curriculum focused on pain management and alternatives to opioids.
Wolf said he will sign the bills.
“Though some believed Harrisburg could no longer tackle Pennsylvania’s greatest problems, the last several months demonstrate that we can come together to compromise and get things done,” Wolf said in a statement. “While this is not the end of our efforts on this crisis, or many other important issues facing the commonwealth, we have made great progress, and I look forward to signing these bills into law.”
There were 3,383 reported fatal drug overdoses in Pennsylvania in 2015 — 81 percent of which are believed to have been caused by heroin or opioid use. Many attribute the epidemic to aggressive physician efforts to control patient pain by overprescribing opioids such as Oxycontin. Abuse of pills sometimes leads to heroin use.
In August, Pennsylvania launched a database on prescription drug dispensing in an effort to prevent their abuse.
Kabazie said he has treated many patients who tell him their doctors prescribed opioids for legitimate pain issues but never warned them about the hazards of addiction.
“As doctors, we should have been more at the forefront of this problem,” he said. “I know there are other physicians in the field who feel the same way.”
Dr. Ajay Wasan, director of pain medicine at UPMC, agreed that some doctors are to be blamed for overprescribing opioids.
“Overall, these bills establish what the standard of care should be,” said Wasan, who is a professor of anesthesiology and psychiatry at the University of Pittsburgh School of Medicine. “If you are a physician doing the right thing, great, keep it up. If not, you need to change. It’s reasonable for the Legislature to spell out the best practices and make it a law to really remind doctors what the best practices should be.”
Dr. Carol Fox, chief medical officer at Excela Health in Greensburg, didn’t appear to be thrilled with the philosophy behind the bills.
“Medicine, by its nature, takes into account the unique needs of each patient,” Fox said. “Legislating care, while seemingly beneficial, can have some unintended consequences that may not be in the best interest of those receiving care.”
Colleen Hughes, executive director of the Westmoreland Drug and Alcohol Commission, said she specifically was pleased with the database requirements.
“It’s a big step and a significant step,” she said. “It’s a fact that doctors contributed to this problem, as did pharmaceutical companies. Forcing doctors to always check the database could help addicts from jumping from one doctor’s office to another to fill prescriptions.”
David Hickton, U.S. Attorney for Western Pennsylvania, has been vocal on various fronts in the battle against opioid addiction.
“My reaction to this legislation is positive,” he said. “We have to make sure that it works and it is used. I’ve been very public in sharing my beliefs that too many opioid pills are being prescribed.”
Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991.