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Proposed Pennsylvania Bill Would Force Patients With Chronic Pain Into A Treatment Agreement

A bill introduced in the state would require all chronic pain patients to enter into an agreement with their doctor before being prescribed opioid medication for the first time.

Women work in a recycling business operated by the American Rescue Workers in Williamsport, Pennsylvania, a city that has experienced an epidemic of opioid use.
Spencer Platt/Getty Images

Proposed Pennsylvania Bill Would Force Patients With Chronic Pain Into A Treatment Agreement

A bill introduced in the state would require all chronic pain patients to enter into an agreement with their doctor before being prescribed opioid medication for the first time.


Proposed legislation in Pennsylvania could add more roadblocks to those seeking pain relief amid a widespread crackdowns on opioids, and even profoundly intrude into their private lives.

House Bill 2431, introduced by Representative Todd Stephens of Montgomery County, would require all chronic pain patients to enter into a treatment agreement with their doctor before being prescribed opioid medication for the first time.

Under the agreement, before opioid drugs are prescribed, patients would be required to undergo a urine screening to test for the presence of any illicit drugs. Patients would also be required to consent to regular urine screenings at their doctor’s discretion.

Stephens’s bill, which was referred to the Pennsylvania House’s Committee on Health in late May, would provide exceptions for cancer patients and for palliative care.

“Enacting public policies [like this] is necessary to address the Commonwealth’s opioid crisis and to protect the health, safety and welfare of affected citizens in Pennsylvania,” Stephens wrote in a co-sponsorship letter for his bill.

But there is little evidence that Stephens’s bill would mitigate the opioid crisis.

“This blowback is serving to deny [pain patients] the care that they need,” Terri Lewis, a professor of Rehabilitation Counseling at the National Teacher’s University of Changhua, told The Appeal.

Lewis said that the response to the opioid crisis has conflated patients who use pain medication for long-term treatment with those who have opioid use disorder.

She added that public policies that continue to impede chronic pain patients from receiving opioid medications can cut them off from treatments that “offer them a path to improved function.”

“It’s bad news all the way around,” she said.

In Oregon, meanwhile, there is a regulatory proposal that would eliminate the prescribing of all opioids to most chronic patients.

Pennsylvania already implemented prescription opioid supply-control policies, such as a drug monitoring program. The state’s former physician general, Carrie DeLone, warned that such policies would lead to an increase in overdose deaths attributed to heroin and other opiates as the supply of prescription opioids shrunk. Indeed, overdose deaths in the state nearly doubled between 2014 and 2016, according to the Pennsylvania Coroners Association.

The Stephens bill, however, targets only prescription opioids, which make up a small fraction of overdose deaths. In 2016, prescription opioids were detected in only 12 percent of fatal overdose victims in the state, according to the Pennsylvania State Coroners Association. The main drivers of overdose deaths are heroin and fentanyl, which were found in nearly half of all toxicology reports for fatal overdose victims in the state in 2016.

A recent study led by Stefan Kertesz, a professor of preventive medicine at the University of Alabama,  found that reductions in prescription opioids have little impact on reducing overdose deaths.

The study’s authors called the outcomes of these supply-side policies “suboptimal,” noting “opioid prescriptions have fallen but harms to pain patients, and overdose deaths have risen.”

While evidence suggests Stephens’s bill will not reduce the number of overdose deaths in Pennsylvania, it could add a major boost to the growing industry of drug testing.

A 2017 report by Kaiser Health News found that spending on urine and genetic screenings quadrupled between 2010 and 2014 and now exceeds the total budget for the Environmental Protection Agency. The study analyzed Medicare and private insurance data and an estimated $8.5 billion was spent on these tests alone in 2014.

“I don’t know who wrote this bill, but the money being spent by various facets of industry that are trying to get their product positioned into the opioid crisis for monetizing things … it’s a heavy push,” says rehabilitation expert Lewis.  “And legislators are very vulnerable because they know nothing [about the opioid crisis].”

Stephens has insisted that his bill is based on 2016 Center for Disease Control and Prevention (CDC)  guidelines for opioid prescribing. But in 2017, Pain News Network conducted a survey which asked chronic pain patients how their treatment has changed since the guidelines were put in place. More than 70 percent of respondents said their opiate prescriptions had been reduced or eliminated since the guidelines were released. Respondents also said their quality of life had also diminished; more than 80 percent said their pain had worsened, while 42 percent said they had contemplated suicide because their pain was so poorly managed. And nearly a quarter said they had begun hoarding opiate pills because they were uncertain that they would be able to obtain more from their doctor.

Nearly all of the respondents said the guidelines have been harmful to pain patients—an indication that the regulations in Stephens’s bill would deepen their suffering.