Special NHMS Alert: Board of Medicine Rejects Governor’s 13-Page Proposal - Sets Temporary Opioid Prescribing Rules*

After a four hour hearing, the New Hampshire Board of Medicine on November 4th, concurred with the physicians and the Medical Society, as well as hospitals, pharmacists and nurses present, in rejecting an emergency 13-page rule proposal by Governor Hassan that appears to have been rapidly developed as it contained a number of conflicting and impractical provisions. In addition, a special legislative session was approved yesterday as requested by Governor Hassan through the state’s Executive Council in a 4-1 vote. Lawmakers will meet for a special session beginning on November 18th to debate options to confront the state’s substance abuse problem which is reported to have claimed more than 320 lives last year.

The Board of Medicine approved temporary and limited emergency rules relating to increasing patient information on opioid risks and acceptable national prescribing practices. In a press release, the Board stated that it was “committed to implementing opioid prescribing rules that will allow licensees to provide the best possible care to patients while preventing the diversion of drugs for illegitimate purposes.”  The temporary rules are effective at the end of this week for six months or until replaced by subsequent rules that can be more methodically and thoughtfully completed.

The Medical Society will be adding new tools to its online opioid prescribing site to assist physicians in implementing the Board’s emergency opioid prescribing rules at http://www.nhms.org/resources/opioid

“It will take many hands working collaboratively and collegially to create sustained, workable solutions to reverse these long-standing drug abuse issues and immediately save more lives,” noted James Potter, new NHMS Executive Vice President.

Responding to the concerns voiced at the hearing, the Board of Medicine also laid out a plan to work with stakeholders and the public to facilitate updating currently dated opioid prescribing rules through a multi-step rulemaking process with the goal of completing its work by April 2016, in which the Medical Society plans to be actively involved.

“A culture change has created the current heroin and opioid epidemic, and will take a significant culture change ­– bringing together healthcare providers, law enforcement, educators, elected officials and civic groups – to solve the epidemic,” said Dr. Lukas Kolm, NHMS President. “New Hampshire physicians are committed to partnering with other stakeholders in curbing abuses, treating pain with less dependence on opioids, while ensuring care to patients who require their appropriate and effective use.”

In addition, NHMS will support lawmakers’ efforts to increase funding to upgrade and improve the New Hampshire Prescription Drug Monitoring Program (PDMP).

Please visit the NH Board of Medicine website for more information.  

**Update: A new set of opioid prescribing rules was approved by the NH Board of Medicine on April 6. These will be reviewed by the Joint Legislative Committee on Administrative Rules on April 15.  The emergency prescribing rules remain in effect until May 4.  

Comments

I am a child psychiatrist (also trained in addiction psychiatry) so do not prescribe opioids but treat many children with heroin addicted parents. This situation will not go away with naloxone prescriptions and restrictions on doctor's prescribing. There needs to be funding for more treatment centers including residential treatment and day treatment. There needs to be more support for doctors willing to prescribe suboxone. Once someone is administered Narcan, now what? He/she will return to opioid use because the underlying addiction hasn't been treated. In addition, people will turn to heroin once opioids aren't as available. Heroin is cheap and available.

 As an aside, the legalization of medical marijuana while convening emergency sessions to treat opioid abuse shows a complete mis-understanding of how addiction works. Marijuana is a gateway drug. Once more people have access, I suspect the use of "harder" drugs will go up. 

 I practice in Colebrook. Since moving to this 2,300 resident community in 2006, I have seen over 70 overdose deaths- that's approximately 8-9 per year for this small community. Until recently, I have treated up to 100 local residents with Suboxone for there narcotic dependency. I have provided the NH and VT  Drug Task Force with names, phone numbers and delivery times of heroine which is being brought into the community. With 9 years of experience working successfully with these young adults, please feel free to contact me in an advisory capacity.

 

Bruce D. Latham, DO

(603) 237-9800 office

blatham@myfairpoint.net

The problem of idaenquate inpatient coverage has been a long standing problem. Another worsening trend is the requirement for precertification to prescribe Suboxone in an outpatient setting. This is a time consuming exercise which adversely impacts on the willingness of certified prescribers to treat patients addicted to opiates due to the excessive time burden necessary for many insurance companies or their managed care subsidiaries. It is absolutely a penny wise, pound foolish approach by insurance, since the treatment with suboxone on an outpatient basis is multiple times less expensive than the cost of even a 7 day inpatient treatment. I would venture the opinion that the outcomes of this outpatient office based treatment are equal or superior to the short inpatient stays that insurance will currently cover. However, many suboxone certified physicians do not want to deal with the hastle fo these precerts and the result are patients unable to find a doctor willing or with the openings to treat them. Dr. Shore