<p>Damaging State Legislation Regarding Opioids: The Need To Scrutinize Sources Of Inaccurate Information Provided To Lawmakers</p>

Abstract

On January 22, 2019, a Massachusetts State Representative introduced House Bill 3656, "An Act requiring practitioners to be held responsible for patient opioid addiction". 1 Section 50 of this proposed legislation reads, "A practitioner, who issues a prescription for a controlled substance placed in Schedule II, which contains an opiate, shall be liable to the patient for whom the written prescription was written, for the payment of the first 90 days of in-patient hospitalization costs if the patient becomes addicted and is subsequently hospitalized". The bill was assigned to a joint House/Senate committee, and the Representative testified in a hearing of the Joint Commission of the Judiciary on September 17, 2019. According to the Representative, the Joint Commission "didn't vote on it, and I don't suspect it will ever get a vote". After speaking to him, he acknowledged that the bill would not be resurrected. When asked of the source of medical information on which he based his bill, the Representative mentioned the name of a nationally known addiction psychiatrist. Unfortunately, this psychiatrist, to the best of our knowledge, had no training or clinical experience in treating chronic pain, nor has he published research on the topic area. Irrespective of the ultimate status of the legislation, its introduction and consideration by the state's Joint Committee on the Judiciary has caused unnecessary anxiety among patients with pain and the physicians who treat them, not only in Massachusetts, but throughout the United States. Although some have denied that legislation curtailing opioid prescription has a significant "chilling effect" on prescribers, 2,3 Ballantyne and Fleisher were not in agreement with this denial. 4 They noted that going back to the early twentieth century, legislation limiting opioid prescription resulted in "an immediate switch of the moral imperative from patient to physician, and in fact a chilling effect on the provision of opioids for pain", and that the "stigmatization and criminalization of opioids produced by regulations continues to interfere with the rational use of opioids for pain to this day (p. 365)". Ballantyne and Fleisher were not the first to write of this potential for illconceived legislation to result in physician fear of prescribing, 5-7 although many more have addressed this concern subsequent to the publication of their article. 8-17 Some pain management professionals have blamed the current suffering and potential suffering of chronic pain patients and those who prescribe opioids to them on the 2016 Centers for Disease Control and Prevention (CDC) Guideline for

Opioid Policy and Chronic Pain Treatment Access Experiences: A Multi-Stakeholder Qualitative Analysis and Conceptual Model

“…9 Additionally, patients with chronic pain commonly experience stigma, manifesting as clinician disbelief in their pain, 10,11 a view that opioids are illegitimate treatment, 12 or assumption of an opioid use disorder. [13][14][15] This stigma may affect clinician-patient relationships and further reduce the number of clinicians willing to treat chronic pain. Stigma also can influence governmental policies, guidelines, and health-system factors, limiting access to effective care.…”

Tackling the overdose crisis: The role of safe supply

“…Current U.S. Federal regulations (Title 42 of the Code of Federal Regulations Part 8) serve as a barrier to off-label use of opioids and other scheduled substances. Statelevel regulations that induce fear among, or outright penalize, physicians for opioid-prescribing (Davis, Lieberman, Hernandez-Delgado & Suba, 2019;Schatman & Shapiro, 2019) are likely to further impede safe supply program implementation and require supporting regulatory changes. Further, the lack of evidence supporting these regulations (Davis, Piper, Gertner & Rotter, 2020) only further points to the public health imperative to instead shift emphasis to harm reduction.…”

Persistent Spinal Pain Syndrome: New Terminology for a New Era

“…Those who have a negative opinion on opioid use have done their best to influence policymakers and shame medical opioid users in a misguided effort to curb the illicit opioid crisis with which the United States is currently faced. 18,19 Additionally, the word "failed" in "failed back surgery syndrome" is ambiguous, which creates another ethical imbroglio. Due to its ambiguity, the question of whether the surgeon or the patient is "responsible" for the "failure" is not clearly answered.…”