Tag Archives: Governor Christie

New Jersey Becomes First State In The Nation To Mandate That Physicians And Other Prescribers Must Discuss Addiction Risks With Minor Patients

Governor Chris Christie signed legislation requiring physicians and other health care prescribers to discuss with an emancipated minor, or the patient’s parent or guardian if the patient is under the age of eighteen (18), the risks of developing a “physical or psychological dependence” before prescribing a Schedule II opioid drug.  Controlled Dangerous Substances (CDS) are prescribed based upon one of five (5) classifications contained in the State’s regulations with Schedule I drugs having the highest potential for abuse. A Schedule II drug would include medications such OxyContin or Vicodin.

If the prescriber determines in his judgement that alternative treatment is appropriate, he or she may discuss the alternatives with the minor or parent. The prescriber is also required to include a note in the patient’s medical record documenting that a discussion about the risks has occurred.

This law is just one part of Governor Christie’s high priority initiatives to “stem the tide of drug addiction that has largely been caused by the misuse of prescription drugs.”  Governor Christie’s Administration is working on many fronts to “curb this epidemic.”

Obtaining the adoption of the new law was a multi-year initiative due to the opposition of medical professionals who argued that they already appropriately assessed and treated minor patients in acute pain. When legislation similar to the above law was first introduced in the 2014-2015 legislative session, it contained many more stringent requirements for how a physician or other prescriber would have to prescribe opioids.  For example, that legislation applied to all patients, not just minors.  It also required that the prescribers use a form created by the Division of Consumer Affairs (Division) to document that the discussion took place.   The Division was also empowered to create “guidelines” for the discussions with patients.

Due to the opposition of Assemblyman Herbert Conaway, (D Burlington), a physician and attorney, who is the Chairman of the Assembly Health and Senior Services Committee, the 2014-2105 Legislature did not pass the bill in the Assembly.  Dr. Conaway stated that the legislation would “unnecessarily interfere with the doctor-patient relationship.”

At the same time, the New Jersey Board of Medical Examiners (BME) supported the “concept” contained in the 2014-2015 legislation, but it stated that physicians were already required to meet the discussion and documentation requirements under the standard of care.  The BME also noted that the patient’s physician is in the best position to assess what information should be discussed and pain medications ordered.  The BME is generally not in favor of legislation mandating how a physician may care for patients.

After extensive debates between families, those concerned about drug abuse and legislators, a compromise was forged on the issue of mandating what a physician would be required to tell a minor patient.  Thus, new legislation was introduced in the 2016-2017 legislative session. Significantly, this legislation did not contain language mandating that a prescription should only be prescribed in “good faith” and codifying the BME’s CDS regulations among other prior provisions. The Legislature passed legislation simply requiring discussions between minors and prescribers and documentation of that communication in the medical record.

In view of the adoption of this “bare bones” legislation it is not surprising that in January Governor Christie directed Attorney General Christopher Porrino to implement emergency regulations limiting medical providers to issuing only an initial five (5) day prescription of CDS for acute pain. Governor Christie has signaled his unwillingness to wait for the Legislature to pass bills adopting the types of limitations on prescribing CDS to patients that he thinks are necessary.  Attorney General Porrino sent a January 18, 2017 letter to the BME informing them that they had thirty (30) days to determine whether they will “stand” with him in pursuing “administrative reforms.”   The clear implication is that if the BME does not go along with the five (5) day prescription limitation on opioids that emergency regulations will be adopted without the BME’s input.

We should anticipate that there will continue to be stringent efforts by Governor Christie’s Administration to take action against physicians and other prescribers who violate the evolving standards for prescribing CDS.   Meanwhile, physicians are arguing that the current regulations governing how they treat patients with acute pain are appropriate and that they should not be limited to only prescribing a five (5) supply of pain medications.  Prescribers are expressing concern about the impact on patients in pain if this emergency regulation is adopted.  Prescribers are also concerned about sufficiently documenting that their communication with a minor patient occurred if that a complaint is made or an investigation launched.

 

Alma L. Saravia is a shareholder of Flaster Greenberg PC in Cherry Hill. She practices in the area of health-care law and was a member of the N.J. State Board of Medical Examiners. She can be reached at 856.661.2290 or alma.saravia@flastergreenberg.com.

Governor Chris Christie Vows To Limit Initial Prescriptions For Pain Medications – Medical Community Reacts

At Governor Christie’s State of the State address last week he emphasized again that fighting drug abuse and addiction is a top priority.  One of his proposals has already drawn a strong reaction from the medical community.  Governor Christie proposed that physicians should be limited to prescribing a five-day supply of pain medications for acute conditions. Under the current law a physician may write a prescription for up to a 30-day supply of pain relief medication.  Last year Connecticut, Massachusetts, Maine, New York and Rhode Island restricted initial prescriptions for acute pain medications to a seven-day supply. New Jersey’s proposed five-day prescription limitation could be the strictest in the country.

In his address, Governor Christie said that a 30-day supply “is dangerous, ill-advised and absolutely unnecessary.” His goal is to limit prescriptions to five days so that patients in acute pain must consult with their physicians before they can receive another prescription.  Governor Christie’s assertion that a 30-day supply is “excessive” is unfounded and it may result in more harm to patients in pain than good, according to physicians.

Nonetheless, on January 17, 2017 Governor Christie signed an Executive Order directing the State’s Attorney General, Christopher Porrino, “to take all necessary steps to limit the initial prescription of opioids for acute pain.”   Last week Attorney General Porrino sent the Board of Medical Examiners (BME) a letter stating that he will seek to implement the five-day prescription limitation as an emergency adoption which would become effective upon its filing with the Office of Administrative Law.  He asked the BME to “support and assent” to the initiative no later than February 16, 2017.

The BME is charged with regulating physicians and other providers – the BME also adopts regulations on standards of practice including the requirements for prescribing pain medications to patients.  The BME’s recognizes the prescribing concerns raised by Governor Christie, such as the risk of a patient becoming addicted. Therefore, it recently voted in favor of a recommendation that all physicians must “familiarize” themselves with the Centers for Disease Control and Prevention guidelines for prescribing pain medications. The BME also continues to make disciplinary actions against physicians who engage in indiscriminate prescribing its highest priority.

Pursuant to the BME’s regulation on limitations for prescribing controlled substances, physicians must assess patients and develop treatment plans before prescribing for pain. The BME’s regulation limits the quantity of Schedule II pain medication (drugs most likely to be addictive) to a 30-day supply or 120 dosage units, whichever is less based upon its findings that this standard meets current medical evidence.  The federal Drug Enforcement Agency (DEA) does not limit Schedule II drugs to a 30-day supply.  The DEA merely provides that the amount prescribed must be for a “legitimate medical purpose.”

Limiting a physician’s ability to determine what is best (and legitimate) for patients has the medical community up in arms.  The State Medical Society’s opposition to this proposal is not surprising as the proposal is widely viewed as an intrusion into the physician-patient relationship.  New Jersey’s 30-day supply regulation is currently stricter than many states requirements, although certainly not as stringent as the five states mentioned above which have seven-day pain medication limitations.  Imposing even narrower limitations on physicians who treat pain “is not the way to go” according to the Chair of the American Medical Association’s Opioid Use Committee.  However, New Jersey may soon see changes in the amount that may be prescribed for acute conditions regardless of whether or not the BME decides to “stand” with the Attorney General emergency regulatory amendment.

Physicians will continue to be concerned about the impact on patients from the five-day proposal and the increasing efforts to discipline physicians who allegedly have engaged in indiscriminate prescribing.  Our experienced healthcare attorneys regularly represent physicians in disciplinary actions before the BME and we handle cases where physicians’ licenses may be suspended or revoked due to allegations of over-prescribing without medical justification.  Our role as counsel in these cases is to ensure that physicians are afforded due process and the opportunity to present evidence supporting the medical care they rendered.  During these challenging times for physicians, knowledgeable counsel is vital.

 

Alma L. Saravia is a shareholder of Flaster Greenberg PC in Cherry Hill. She practices in the area of health-care law and was a member of the N.J. State Board of Medical Examiners. She can be reached at 856.661.2290 or alma.saravia@flastergreenberg.com.

%d bloggers like this: