Working Together on AB 474
Well, it is finally here. AB 474 and all of its components are now the law of the land. If you are a physician that does not to have to prescribe scheduled medications, you can consider yourself lucky. It is rare to see physicians from every specialty and subspecialty united in something, however, it seems that every physician that I know is united in the fact that they do not like this law. Obviously, there are physicians that over-prescribe opioids, however, the other 99 percent of physicians are now forced to understand all the aspects of this law before they write a prescription, or their license could be revoked.
The Clark County Medical Society (CCMS) in conjunction with the Nevada State Medical Society (NSMA) has been working with the legislature. Unfortunately, there were politicians that did their best to make it as difficult as possible for physicians to write controlled substances for their patients. Prescribing controlled substances without the proper consent forms, PMP checks, ICD-10 codes on prescriptions and many other different requirements now results in strict penalties. Unfortunately, there is nothing in this law forcing insurance companies to pay for addiction treatment.
I’d like to share a recent letter to CCMS from one of our members: “Being a psychiatrist, a psychopharmacologist, an addictionologist, a morphinologist and all around ‘good guy.’ Having research studies, publications as well as teaching and clinical experience in the above areas over the past 49 years, this law does not address the basic recognition of the illness of addiction and specifically opioid addiction. There is no new opioid crisis. It has been with us since the beginning of the last century. Politicians do not make good clinicians.
“But you and others in the NSMA/CCMS and other concerned staff and doctors have been of monumental assistance in helping us deal with the reality of this law. Thanks again.”
My prediction is that heroin will become the opioid of choice for opioid addicts and the morbidly curious thrill seekers. Some will be laced with Fentanyl. Overdoses and death rate will increase. It may take a while, as with all addictions but it is a likely outcome. Addictive illnesses and treatments need long-term follow up. Progress of the disease and effectiveness of treatment need to measured in at least 5, 10, and 15 year studies. Addiction (which includes alcoholism) is a chronic, not acute, illness more like hypertension, diabetes type II and some cancers.
Recently, the NSMA put out the following statement:
"As you are aware, AB 474 -- which regulates how physicians prescribe narcotics -- is going into effect on January 1. This bill includes many new regulations on giving patients informed consent about their narcotic pain medications and running PMP reports. For patients on long term narcotics, new regulations require urine drug screens, medication contracts, and assessment for abuse potential.
One of the questions we often get from physicians who are not NSMA members is "why should I join?" AB 474 is a good example of the importance of organized medicine. NSMA (and CCMS) staff and physicians have been involved with the bill from its beginnings. While the bill isn't perfect, the bill is dramatically improved from the original version due to OUR input.
The benefits of being an NSMA member do not stop there. In the past few weeks, Cat O'Mara, the NSMA, staff and NSMA physicians have been working diligently to put together the tools and protocols you will need to comply with AB 474. We have been meeting with the Nevada Department of Health and Human Services along with the State Pharmacy Board to try and ensure as smooth of a transition as possible. In addition, we have also been reaching out to the community to educate our patients on these new regulations.
To help our members, we have put together this information on the NSMA webpage (https://nvdoctors.org/practice-resources/prescribing-opioids/), and we have also been instrumental and helping DHHS put together these check lists and sample informed consent, medication agreements and prescriptions.
We will also continue to organize educational opportunities to help our physicians in 2018."
When you meet physicians of Clark County that are not members of CCMS/NSMA, please remind them that this law could have been so much harder on physicians and their patients without the input of the members of the NSMA and the CCMS. We are trying our best to take care of our patients despite the interference of the government, but we need more members to make this goal more likely to succeed. If you know someone that is frustrated with this law and they are not members of this society, please ask them to join as the more members we have, the more we can change the current laws.