Last week, State Sen. James Brewster, a Democrat representing parts of Alleghany and Westmoreland Counties, introduced three opioid-related bills. The bills — co-sponsored by State Sen. Vincent Hughes, a Democrat from Philadelphia — would impose limits on opioid prescriptions, coerce people into long treatment, and impose stricter penalties on drug dealers caught with an illegal firearm.
Setting aside the bill that aims to take illegally-armed dealers off the street, the prescription limits and coerced treatment bills are aggressive interventions that are likely to do more harm than good.
The goal of prescription limits is to prevent addiction from starting. Brewster’s bill proposes a strict — and arbitrary — dosage limit of 100 morphine milligram equivalent and of 300 MME for patients already receiving more than 100. That would prevent some patients from receiving the appropriate amount of painkillers and will force a small number of chronic-pain patients who require a high dose of opioids to abruptly reduce the dose that they receive.
This type of legislation is based on the popular notion that the driver of the opioid crisis is people being prescribed too many — or too high a dose of — opioids by a physician after getting a tooth pulled or spraining an ankle and got “hooked.” The reality is that, according to the Substance Abuse and Mental Health Administration, the majority — about 80 percent — of people who misuse prescription opioids get or buy pills from friends and family, not from a doctor.
Reducing the number of unnecessary opioid pills in the community is important. But it should be done through education, not hard limits.
The state Department of Health is working with physicians to ensure that they prescribe opioids carefully and judiciously. The department issued 11 opioid prescribing guidelines to help physicians prescribe appropriately in different scenarios; crafted curriculum on pain, opioids, and addiction for all medical students in the state; and required physicians to attend continuing education on these topics. The state also has a Prescription Drug Monitoring Program that tracks prescription patterns in the hope of catching bad actors.
Forcing pain patients to reduce their dose of opioids, or not allowing a prescriber to give a patient the dose that they need, leads to suffering, to pain patients searching for illicit and more dangerous alternatives, and in some cases, to driving pain patients to commit suicide.
Coercing treatment also is not a solution. Brewster’s bill would mandate almost a year of inpatient treatment for people with addiction who have been treated for overdose in the past and were convicted of minor offenses.
According to health-law experts, coerced treatment is not an effective way to treat addiction. Brewster’s bill is especially problematic because it creates a disincentive for people with addiction to call 911, as being treated for an overdose would put a person at risk for long incarceration in a treatment facility. This bill will directly undermine the overdose-prevention efforts of the Commonwealth.