Both state legislators from Butler County and doctors say the opioid drug addiction crisis must be addressed from a variety of angles, but current Pennsylvania House bills are focusing on the medical community.

Multiple bills addressing the opioid addiction crisis have come out of the state House and are in the Senate, including a bill to limit how much of an opioid emergency room doctors can prescribe. This is the result of a bipartisan task force to fight opioid addiction, created by the House in 2014. One of those bills, House Bill 1511, cited more than 2,500 drug overdose deaths in the state in 2013.

House Bill 1699

The Safe Emergency Prescribing Act passed the state House in June. Also known as House Bill 1699, the bill limits an ER doctor to prescribing no more than seven days’ worth of an opioid drug, except in certain situations. When prescribing more than that, the doctor must document it in the patient’s medical record and state that a nonopioid drug was not an appropriate alternative.

The legislation is now in the state Senate Public Health and Welfare Committee.

Sen. Donald White, R-41st, said prescriptions start the path to drug abuse, agreeing with the intent behind the House’s bill.

“I do believe there is merit in limiting prescriptions and providing continuing education to all professionals who prescribe drugs,” he said. “It is widely believed overprescribing of medication is one of the most significant gateways to drug abuse, and efforts to limit prescribing too much medication should be pursued.”

But some doctors are uncomfortable with legislators telling them how to do their jobs, according to Dr. David Rottinghaus, the medical director of the Butler Health System’s emergency department.

“All of the people I know in the field do not prescribe long-acting opioid prescriptions except in rare cases, something that requires a lot of diligence and thought,” he said. “Doctors are not by and large prescribing large numbers of opiates. We’re generally prescribing three to maybe five days of pain medication and requiring follow-up with a doctor ... We’re already doing the things that are in that bill.”

Rottinghaus said an emergency room doctor will typically prescribe opioids for just long enough to let a patient see their regular doctor, and this is what legislators intended with the bill, according to Sen. Scott Hutchinson, R-21st, who serves on the Public Health and Welfare Committee.

“What we’re saying is, ‘An ER doctor cannot prescribe a large amount,’” Hutchinson stressed. “We’re not saying that these people can’t get a small amount and then go to their doctor who works with them day in and day out. It’s more appropriate for your doctor who works with you on a regular basis to make these long-term decisions.”

Pennsylvania doctors are required to check a database when they prescribe to a new patient or if they believe a patient could be abusing drugs, Rottinghaus said.

That became law in 2014, making Pennsylvania the 49th state to require doctors to report any prescription for certain controlled substances, like morphine, codeine and opiates.

House bills 1698, 1805

Another bill from the task force is House Bill 1698, which also passed the House in June and is in the Senate’s Banking and Insurance Committee. That bill would require a health insurance carrier providing coverage for an opioid to also offer three abuse-deterrent opioid options, “preserv(ing) therapeutic choice for prescribers and patients,” the bill reads.

This is a bill White has expressed some concern over, as the chairman of the Banking and Insurance Committee, saying he is not convinced the abuse-deterrent options are as effective.

State Rep. Jeff Pyle, R-60th, expects health care providers to fight the bill, saying this would cut into profits.

Yet another bill, House Bill 1805, was passed by the House in June, calling for licensing boards to require additional education in pain management, addiction and prescribing opioids. That bill is now in the Senate’s Consumer Protection and Professional Licensure Committee.

Addressing the issue

But government oversight on how doctors do their jobs has the potential to harm relationships with patients, Rottinghaus said.

“Doctors want to preserve and attract that doctor-patient relationship,” he said. “When doctors feel a threat to their autonomy then people get defensive.”

State Rep. Tedd Nesbit, R-8th, said legislators are aware of this.

“Generally, I don’t think the legislature should get in the way of what doctors do for their patients,” he said. “We need to make sure that we reach a balance between trying to protect citizens from the opioid crisis and at the same time, making sure that doctors can interact with their patients.”

Rottinghaus said doctors have seen the development of the opioid addiction crisis for quite some time now, and legislation focusing on doctors provides “little to nothing to end the tide of opiate abuse.”

“In the late ’80s and certainly in the ’90s, the federal government touted pain as something that nobody should endure. Lots and lots of new pain medications were launched into the market,” Rottinghaus said. “We’ve seen this coming for a long, long time. We’ve seen the opioid crisis evolve ... and I don’t believe the doctors are the problem.”

Because doctors have been mindful of prescribing opioids, according to Rottinghaus, solutions need to focus on more holistic approaches to prevent and treat addiction.

“I don’t think hospitals are the way to go. The place to go is to the streets, to curb the distribution of the medication,” he said.

“I like (legislators’) efforts and their interest, but pass something that will make an impact, have meaningful change and protect people ... Oversight has to incorporate the FDA. We have to be selective about which drugs we improve and allow on the market,” Rottinghaus said.

Nesbit agreed that legislators must look at addressing the issue in a variety of ways.

“In the end, we can’t pass a magic law that’s going to fix this,” he said. “We need the entire community to come together and try to get a handle on it.”

With the end of the Legislature’s two-year session approaching on Nov. 30, Pyle does not expect the Senate to pass the bills. However, Pyle said there is speculation about a weeklong session being added around Thanksgiving for legislators to focus specifically on opioids.

Pyle is hopeful that the bills will be rebooted and passed early in the next session, which starts in January.

“The next session ... that’s when the gears are getting engaged, and the bills will start becoming laws,” he said.

Regardless, State Rep. Brian Ellis, R-11th, called the bills “meaningful recommendations,” and hopes the Senate will work quickly.

“Due to the fact that this opioid crisis is affecting all groups of Pennsylvanians, not differentiating by age, income, region, race, religion or any other factor, the House has been serious about creating solutions that will make positive impacts,” Ellis said.

“I am hopeful that the Senate will pass these bills as soon as they return to session so we can continue to work on solutions at the state level.”