June 13, 2017
Senator Fred Erick J. Akshar, II
805 Legislative Office Building
Albany, NY 12247
Re: Senate Bill 5949 and Senate Bill 5670
Dear Senator Akshar:
We are writing to you to express our concerns with the above-referenced legislation. While we applaud the efforts of the Legislature generally to respond to the heroin and opioid abuse crisis in this state, we are concerned that these specific proposals will go beyond addressing the crisis and have the effect of discouraging physicians from addressing their patients’ legitimate pain needs.
To begin with please be aware of MSSNY’s and the New York physician community’s efforts to respond to this crisis. MSSNY is a member of the American Medical Association Opioid Task Force and is working with the AMA, national medical organizations, and other state medical societies across the country to end the opioid epidemic. We are beginning to see the results of these efforts. According to the AMA Opioid Task Force, every state in the nation saw a decrease in opioid prescriptions beginning from 2012 to 2016! Specific to New York, since enactment of the ISTOP law in 2012, there has been a 13% decrease in opioid prescribing during 2013-16. New York physicians and other health care professionals used the state Prescription Monitoring Program (PMP) more than 51 million times between 2014-2016 – by far the most in the nation!
Furthermore, due to changes in state laws, New York State has also seen an increase in medicated assistance therapy and enhanced use of naloxone by physicians, other health care providers and the community at large. As you are also aware, in 2016, the New York State Legislature
also required mandatory education for pain management, palliative care and addiction for every prescriber who is licensed under Title Eight of the Education Law and who holds a DEA license, to complete a course by July 2, 2017, and every three years after that. To date the Medical Society has educated thousands of physicians on Pain Management, Palliative Care and Addiction, and tens of thousands of physicians across the state have taken similar courses.
With regard to S. 5949, we are concerned that the bill does not take into account other sections of law, such as Public Health Law 2504, which define the circumstances when a minor may make health care decisions for themselves. For example, recent statutory changes have resulted in regulations allowing minor consent for HIV Treatment Access and Prevention. These updated regulations related to Expansion of Minor Consent for HIV Treatment Access and Prevention were announced
in the in April. Additionally, New York Codes, Rules and Regulations, Title 10, Part 23 has long established the legal capacity of minors to consent to treatment and preventive services for sexually transmitted diseases (STDs). Provisions in Part 23 require that the Commissioner of Health promulgate a list of STDs. A 2016 amendment to Part 23 added HIV to the list of STDs, thereby bringing minor capacity to consent to HIV treatment and preventive services on par with other STDs.
With regard to S.5670, the Medical Society believes that patient education that would be required by this legislation is already being accomplished by the requirement enacted last year to have pharmacists provide education to patients at the time of filling the prescription. Therefore, MSSNY believes that this legislation is unnecessary and duplicates efforts. Furthermore, the Centers for Disease Control and Prevention issued its “2016 Guideline for Prescribing Opioids for Chronic Pain” and reiterated its call for starting a patient out on “the lowest opioid dose possible”. These guidelines are now in effect, and have become an important tool to prevent over-prescribing and identify the signs of addiction while meeting the needs of patients in pain. The CDC’s National Center for Injury Prevention has also issued its “Common Elements in Guidelines for Prescribing Opioids for Chronic Pain” and these include having prescribers:
- Conduct a physical exam, pain history, past medical history, and family/social history
- Conduct urine drug testing, when appropriate
- Consider all treatment options, weighing benefits and risks of opioid therapy, and using opioids when alternative treatments are ineffective
- Starting patients on the lowest effective dose
- Implementing pain treatment agreements
- Monitoring pain and treatment progress with documentation; using greater vigilance at high doses
- Using safe and effective methods for discontinuing opioids (e.g., tapering, making appropriate referrals to medication-assisted treatment, substance use specialists, or other services
- Checking the Prescription Monitoring Program
Moreover, as you know, in 2016, the New York State Legislature imposed a strict seven day limitation for prescribing of an opioid for an initial consultation for acute pain further limiting access to these types of medications.
With both of these legislative proposals, we are concerned that the very detailed requirements imposed on physicians will discourage physicians from treating patients with pain treatment needs, or avoiding writing prescription for pain medications even if their patients need them.
Thank you for your time and consideration. Again we are very much committed to working with you and the Legislature to reverse the opioid epidemic, but legislative proposals must be balanced and ensure that patients who are suffering from chronic and acute pain can continue to receive needed medications.