New Drug Rules For Doctors Would Regulate Pain Treatment

Aug 22, 2014

Two years ago, lawmakers asked the Vermont Department of Health to come up with rules to prevent the abuse of narcotic painkillers. Now, health officials want to impose new regulations on doctors prescribing the drugs.

Health department officials say they don’t want to tie doctors’ hands when it comes to treating chronic pain. But they do want to stem the flow of narcotic painkillers, like Percocet or Vicodin, into the hands of people who might misuse them. And a proposed rule would require doctors to clear a series of diagnostic hurdles before prescribing opioids for patients suffering from chronic pain.

“It is really about screening patients for potential abuse and diversion, looking at whether or not there are alternative … treatments, and also doing assessments, and looking at the patient individually and recording in the medical record those factors that support the use of opioids or perhaps don’t,” says David Englander, the senior policy and legal advisor at the Vermont Department of Health.

"It is really about screening patients for potential abuse and diversion, looking at whether or not there are alternative ... treatments, and also doing assessments, and looking at the patient individually and recording in the medical record those factors that support the use of opioids or perhaps don't." - David Englander, Vermont Department of Health

Englander says doctors have in many cases already adopted abuse-deterrence protocols voluntarily.

“But at the same time there’s a place for certain kinds of regulation that establish a floor for prescribers,” he says.

The proposed rule focuses largely on the treatment of chronic pain that is not caused by cancer. And it would require doctors to perform, and document, a risk-benefit analysis on the use of opioids for a patient before prescribing them.

Doctors would also be required to check the patient’s name on the Vermont Prescription Drug Monitoring System, to ensure they aren’t already receiving narcotics prescribed by a doctor elsewhere.

In cases where opioids are being prescribed for longer than 90 days, the doctor must have the patient sign an informed consent form saying they understand the risks of addiction.

Madeleine Mongan, the deputy executive vice president at the Vermont Medical Society, says health care providers are eager to work with the Department of Health “to address this social problem, which is a terrible social problem.”

But Mongan says the Medical Society wants to make sure the new rules are constructed in ways that don’t create an undue administrative burden on doctors already subject to a complex bureaucracy.

"The potential negative outcome would be ... a chilling effect on prescribers' willingness to treat people either with chronic pain." - Madeleine Mongan, Vermont Medical Society

“The potential negative outcome would be … a chilling effect on prescribers’ willingness to treat people either with chronic pain, or people who need medication-assisted treatment for addiction,” Mongan says.

Commissioner of Health Harry Chen is meeting this week with an advisory council, made up of about 30 clinicians, to discuss the proposed regulations.

The new rule also aims to make permanent an emergency action, taken in April, that attempts to tamp down on the use of a powerful new high-dose, extended-release painkiller called Zohydro.

“If an adult bites into a pill, that can be lethal … So we think it’s reasonable to adopt certain kinds of strictures to keep Vermonters safe,” Englander says.

The Vermont Medical Society has no objection to the provision targeting the prescribing of Zohydro.