There was news recently that Republican members of the North Carolina General Assembly had teamed with leftist Attorney General Josh Stein to announce a bill to tighten state restrictions on the prescribing of controlled substances.
Officials are justifiably concerned about the number of deaths due to heroin overdoses. That is an appropriate concern, although it is primarily a law enforcement and criminal justice issue. Heroin has flooded our country because the legalization of marijuana in several states has cut into the profits of the Sinaloa cartel that engages in the distribution of illegal drugs. The heroin epidemic was essentially caused by liberal policy-making in other states. Our open borders with Mexico, previously maintained by the federal government, has exacerbated the situation, of course.
The bill proposes to require that doctors consult a statewide computer registry every time they prescribe a controlled substance of any kind. It proposes they limit the amount they prescribe, and forces them to prescribe electronically. And of course, it levies yet another annual fee against physicians to accompany the numerous other annual fees we must pay.
The theory is that people who use prescription narcotics will inevitably progress to seek and use heroin. I strongly doubt that previous inappropriate use of prescription medications is the primary cause in the vast majority of heroin cases. One article suggests that some of the folks who previously used prescription narcotics are using heroin because it is cheap and easier to access.
In any case, the Republicans ought to know that anything Josh Stein advocates is likely to be horribly wrong.
Requiring the physician to use an electronic database, pay a fee and convert to electronic prescribing is yet more regulation of the health care sector. The Republicans claim to want deregulation, but they have a fetish for regulating health care. They repeatedly impose requirements upon physicians and medical practices. In my own sector of the economy, their claims to cut regulation are but a theoretical fantasy. They continue to pour it on.
It is true that some physicians over-prescribe controlled substances. But the solution is not to impose onerous requirements on everyone for all controlled substances. More targeted solutions would be appropriate.
The measures proposed in the bill would require additional time-consuming, inefficient steps for prescribing certain medications that are not even typically abused. It would penalize physicians who are not part of the problem. And it likely would not reduce deaths due to heroin to a major extent.
The bill does not do anything with regard to patient expectations or demands for narcotics. Americans have become acculturated to ask for (or demand) "something for pain" or "something for my nerves" over a period of many generations.
And in fact, the federal government encourages patient demands for narcotics. Hospitals must achieve Joint Commission accreditation in order to receive Medicare reimbursement. And the Joint Commission demands that hospitals inquire with patients about pain, and manage it. This requirement nearly creates a de facto burden to treat pain with narcotics, because the information solicited must be acted upon. The federal government is therefore a driver of opioid overprescribing and overuse. And corporate entities that employ physicians-- i.e., hospital systems-- also encourage overprescribing because they excessively emphasize patient satisfaction even when patient expectations are inappropriate. Physicians are now penalized by their employers if they do not give patients what they want and expect.
This push to make it difficult to prescribe narcotics is controversial in some quarters because some patients genuinely need this type of treatment. There is an agenda to move away from narcotic prescribing; and that is justified in many instances. But this effort spurs much debate because some patients and providers need to be able to use these drugs. (HT: Fred Gregory)