Peter Schorsch
Consider this column an “open letter” of sorts to the Florida Department of Health.
First, do no harm.
Got that?
Though those words are not actually printed in the Hippocratic Oath, but it’s still an important medical axiom.
Here’s the deal.
The feds recently passed a new law known as “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act” to address the opioid crisis. Good. But as with all large bills, there are some not-so-good parts.
Exceptio probat regulam, this is not.
Included in the sprawling, bipartisan bill is some language that could easily be misinterpreted in a former pill-mill state such as Florida. And, if misinterpreted, that language could end up taking lives rather than saving them.
A bit of background: There are special doctors known as “DATA 2000” physicians who have special training in dealing with drug addiction treatment and can prescribe some pretty serious stuff in order to help afflicted patients. It takes some extra training to join the ranks, and not every doctor takes those steps.
The few who go the extra mile to become DATA 2000 docs offer Medication Assisted Treatment, or MAT, and that includes prescribing power for what are essentially specialized narcotics. A new version of these narcotics may only be administered to a patient in person, either by injection or implant.
These aren’t take-home drugs. These aren’t “take two and call me in the morning” drugs. These are powerful controlled substances that are diligently tracked by the by U.S. Drug Enforcement Administration.
The new federal law allows states — if they so choose — to let DATA 2000 docs prescribe MAT drugs, but for the first time, it also allows non-DATA 2000 docs to administer them.
This bears repeating. These are narcotics with a significant street value and they require specially trained physicians to prescribe and administer.
The new federal law kicks down the door, DEA-style, when it comes to tracking these substances by letting non-trained physicians administer them without even being the doctor with their name on the script or bearing any meaningful responsibility for the patient’s care.
What could possibly go wrong? A lot.
Let’s follow this hypothetical scenario to its logical conclusion, using two doctors. The first, we’ll call him “Doc A,” has DATA 2000 training. The second we’ll refer to as “Doc B” for consistency’s sake, does not.
Doc A writes a script for some of the special, opioid-based MAT drugs, and though he would usually be tasked with administering them he decides, for whatever reason, that he doesn’t want that responsibility.
He faces a couple of options. Option 1: He can kick the can down the road and send the patient to another doctor —Doc B — who works down the street or in the next town, or wherever. Doc B steps in but does not have the proper training and is not lawfully allowed to prescribe the very drug that he would now be tasked with administering.
Taken alone, that’s nuts, right?
Doc B does not have the training, nor the authority to prescribe it, but he or she can and administer it to a patient who isn’t even theirs. Now the patient — who is NOT the patient of Doc B — shows up high. Doc B, not knowing any better, gives the patient the drug and, subsequently, he overdoses.
Great, just great. Any trial lawyers giving this a read — skip ahead a few paragraphs. Seriously. Pay no attention here, please.
Option 2: Doc A writes the script and the pharmacy drops off a batch of those high-powered opiods at Doc B’s office.
The patient, who is after all struggling with addiction, doesn’t show up. Ruh Roh! Now Doc B — he’s the one without the DATA 2000 training, remember — is now in possession of a narcotic with no patient in sight.
The pharmacy does not take back drug which, as stated, is worth its weight in gold on the street. Who is responsible for making sure these narcotics don’t sprout legs and waltz out the door? What, exactly, happens here? Hint: Only bad things at this point.
See the problems?
There are many, many problems with this provision of the SUPPORT Act, not the least of which relates to tracking each patient’s use and whether these high-potency, high-value are where they’re supposed to be.
These are just two of a myriad number of nightmare scenarios this new law could cause. To be clear: This isn’t a “scope” issue. This is a liability issue.
This isn’t saying don’t let doctors prescribe, that would be nuts. This is a “wait a sec, lets develop some guidelines here before someone gets killed” type scenario.
But Florida doesn’t have to settle for taking the good with the bad, and here’s why: State laws are not overruled by the SUPPORT Act. However, Florida needs to take the time to comb through the statutes and regulations on the books and decide how to implement these changes.
Here is my earnest plea to the Florida Department of Health: Please let the DATA 2000 docs know that they should not start prescribing MAT drugs like aspirin or start passing the buck (or the patient) on administering them. Let them know that unless and until you say so, there is no change in the current rules governing these medications.
We have enough people dying from opioids every day in Florida. Let’s not make it worse.
Primum non nocere. Placere!
