The North Carolina House, with its Republican supermajority, passed a bill regarding physician prescriptions for controlled substances. The bill is packed with items compelling certain actions by the private sector.
It requires the following:
- That physician extenders (physician's assistants and nurse practitioners) consult with the physician if a targeted controlled substance is prescribed beyond 30 days, and to consult with the physician every 90 days;
- That prescribers send prescriptions for targeted controlled substances to the pharmacy electronically instead of using written prescriptions, thus imposing additional costs upon private practices that have chosen not to use this technology;
- That prescribers only provide a five day supply for acute pain and a seven day supply for postoperative pain, and that refills only be given after a consultation takes place;
- That pain management agreements be executed with patients for chronic pain situations;
- That the state's electronic controlled substance registry must be consulted before prescribing or dispensing a targeted controlled substance in order to review the patient's medication history over the last 12 months, and that this action is documented;
- That pharmacies be assessed fines and penalties if they fail to make certain reports to the electronic registry.
Interestingly, many of these requirements are waived if the patient is seen in the hospital setting. It thereby forces drug seekers to go to the ER where they will be accommodated more generously.
One of the sponsors of the legislation is Republican Donny Lambeth of Winston-Salem, a former hospital administrator who represents the state's hospital systems in the state legislature. It is also sponsored by Dr. Greg Murphy, a Republican who also appears to be representing the state's hospital systems in the legislature as evidenced by his recent sponsorship of Medicaid expansion.
The controlled substances targeted are mostly Schedule II and Schedule III.
Among the local sponsors of the legislation are Jon Hardister, Pricey Harrison, Bert Jones, Lambeth, Amos Quick, John Faircloth, and Kyle Hall. Joyce Krawiec is sponsoring it in the Senate. John Blust and Cecil Brockman voted for the bill. Even the most conservative members of the Republican conference supported it. The vote was nearly unanimous, except for those legislators who were absent.
The legislation has attracted solid support from Democrats, which indicates that it is probably a bad bill. But the bill that was ultimately passed in the House is somewhat better than when it was initially proposed. Unfortunately, it still imposes onerous requirements among physicians and pharmacists who are not part of the problem. The North Carolina Medical Society supports the bill; and the state's physicians really don't have any organization fighting on their behalf to protect them from excessive state interference in their private practices.
The bill is premised upon the theory that tying physicians and pharmacists up in knots is the best way to solve the opioid crisis affecting our entire country. However, the opioid crisis is multifactorial; and heroin-- the most prevalent bad actor resulting in deaths due to overdose-- is not typically prescribed by physicians. Physicians overprescribing is only part of the mix. Among the contributors to the current prevalence of opoid addiction are the legalization of marijuana in multiple states which forced the Mexican drug cartels to find another profit center; insufficient oversight by the federal Drug Enforcement Administration; and big Pharma pushing certain opioid products among prescribers and with the FDA, using sales reps and lobbyists:
Now, even John McCain is getting into the act. Oppressive state compulsion tends to be infectious, leaping from one jurisdiction to the next.
The North Carolina Senate will now be addressing this legislation. Which legislators among the Republicans in the Senate will fight for limited government? And which will team with the Democrats to pass this legislation?