MARYLAND FACES a horrific opioid epidemic, which claimed nearly 1,100 lives in 2015, the last full year for which data exist. Though a growing share of the toll is attributable to heroin and illicit fentanyl, prescription opioids still account for a large portion: more than 32 percent of the deaths in 2015, to be exact. Legal drugs, often obtained initially with a physician’s authorization, drove the upsurge of opioid addiction in the 21st century and continue to create havoc.
Two months ago, Maryland Gov. Larry Hogan (R) unveiled a legislative package to deal with the crisis, including a plan to limit initial opioid prescriptions to seven days each, subject to renewal — with exceptions for cancer-related pain, terminal illness and the treatment of a substance-related disorder. (Some medications used in addiction treatment are chemically similar.) Doctors who broke the rule could face discipline, including the loss of their state licenses to prescribe controlled substances. Mr. Hogan’s proposal was based on guidelines from the Centers for Disease Control and Prevention released last year, which reminded doctors that opioids are not “first-line or routine therapy” for chronic non-cancer pain and should be used sparingly, after exhausting non-opioid alternatives.
Maryland’s doctors and other health-care providers pushed back, arguing Mr. Hogan’s proposal put them at risk of sanctions and that the “one size fits all” seven-day limit “would prevent physicians and other health care providers from appropriately addressing the unique needs of their patients,” as a letter to the House of Delegates from lobbyists for the state medical society and others put it. They threatened to oppose the bill if it weren’t changed — and now it has been. The version moving through the General Assembly, with Hogan administration support, drops any reference to a seven-day limit in favor of much broader language requiring physicians to follow “an evidence-based clinical guideline,” appropriate, in their “clinical judgment,” to the particular case.
Lobbyists for the doctors argue this is understood to encompass the CDC guidelines, and the various medical-specialty guidelines to which that document, in turn, refers. Perhaps so, but the proposed law’s increased scope seems to come at the expense of specificity. Whatever its other pros and cons, a seven-day prescription limit for an initial consultation is a clear rule. Determining whether a physician followed it would have been a lot simpler than determining whether he or she “followed” a guideline, as it should have been applied, in the physician’s best judgment, to a particular set of circumstances.
The status quo regarding opioids in Maryland is bad. And to deal with it, this law would change the status quo, albeit incrementally, which is why the governor accepted the compromise. Let the record show, however, that this incremental change would come in response to what Mr. Hogan just a month ago declared a “state of emergency.”
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