Doctors eye opioid restrictions

Oct. 21--CONCORD -- Two physician groups ­-- and a task force associated with Gov. Maggie Hassan's own commission reviewing the state's opioid crisis -- have written letters critical of efforts to rush rules into effect that restrict the ability of doctors to write opioid prescriptions.

The organizations have taken the unusual step of writing to the Board of Medicine to comment on draft rules that have been developed behind closed doors but have been making the rounds among doctors, health practitioners and health insurers.

The New Hampshire Union Leader disclosed the rules last week and published them on UnionLeader.com (click here for link).

On Tuesday, the Board of Medicine released correspondence it has received from the 2,200-member New Hampshire Medical Society, a second group that represents emergency room physicians, and a task force associated with the Governor's Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery.

Seddon Savage, a physician-educator at Dartmouth Medical School and the chairman of the Healthcare Task Force, encouraged the Board of Medicine to take the traditional rulemaking route, which involves public hearings, public input and review by a legislative committee.

"Based on our evolving review, it is clear that various mandated policies related to opioid prescribing can have significant impact on patient care that may be positive, but that can result in significant unintended negative consequences as well," Savage wrote.

Also, a state representative who lost a teenage daughter to cancer two years ago said her daughter was able to travel on a Make a Wish trip and do ballet because oxycontin kept her pain in check.

Rep. Terry Wolf, R-Bedford, said the process should be public.

"I just hope we keep an eye on the fact that opioids were created for good reasons," Wolf said. "My goal it to make sure we're being thoughtful."

Hassan wants the rules adopted quickly. Her spokesman said the heroin and opioid crisis is the most serious public health and safety challenge facing the state, and it stems in part from the overuse and misuse of addictive prescriptions.

Spokesman William Hinkle noted that 16 million doses of prescription opioids were dispensed from New Hampshire pharmacies in a three-month period this year.

He said the emergency rules, which can go into effect immediately and without a public hearing, will only be temporary, and Hassan is committed to working to develop permanent rules.

Board of Medicine Executive Director Sarah Blodgett said the board will likely consider the rules in public session on Nov. 4. They could also be voted on then.

The New Hampshire Medical Society has objected to several aspects of the rules, including a requirement for mandatory queries to the monitoring program. Physicians find the program cumbersome already, wrote the organization's president, Dr. Lukas Kohm. On average, a query takes about five minutes, he wrote.

"For the thousands of patients receiving opioid medications, only a tiny fraction become addicted or abuse the medication," Kohm wrote. "We took an oath to "do no harm," so we must be sure that the adoption of any restrictions on the prescribing of opioids does not have a chilling effect that results in less than optimum care for New Hampshire's patients."

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