Ending the epidemic by slapping wrists

PHOENIX — Gov.Doug Ducey, true to his pledge, now has a plan he hopes will stop the preponderance of opioids and reduce addiction rates. How? By giving bad doctors a slap on the wrist and locking up addicts.

Ducey called for an end to Arizona’s opioid epidemic in his 2018 State of the State address, promising that the plan would be aggressive and controversial.

That plan was announced today and is called the Arizona Opioid Epidemic Act. Part of it targets the doctors who prescribe opioids for pain management by permitting medical regulatory boards to access the prescription monitoring database that all opioid prescriptions are entered into. The punishment for doctors writing dangerous prescriptions?

Training classes, suspension of their medical license, and at worst, license revocation.

While that means Dr. Opioid has to find a different career, it doesn’t mean any criminal charges. Those are reserved for the opioid manufacturers, which are currently civilly liable for fraudulent advertising of their products but not criminally responsible. That will change, though it could be difficult to prove that the manufacturers fraudulently conceal the nature of their products when just about everyone knows that opioids are addictive.

There’s a lot more to the issue than the doctors, and Ducey’s proposed Arizona Opioid Epidemic Act would cover many different sectors.

For Margaret Higgins, it is a step in the right direction but may not be the silver bullet in the fight against opioid addiction. Higgins is the  executive director at the Haven, a women’s substance use treatment facility located in Tucson that aids addicts in their recovery.

“I’m in favor of addressing the problem, but I don’t know if everything in the act is the right way to go about it,” Margaret Higgins said.

The governor is throwing everything at the wall to see what sticks. The Opioid Epidemic Act is a grab bag of restrictions and programs both voluntary or otherwise — but enforcement is absent from his proposal.

“Our package will attack this issue form all angles, while protecting individuals who suffer from chronic pain, and maintaining compassion for those struggling with addiction,” Ducey said in his address.

To plug that enforcement gap, Rep. David Farnsworth (R-D16) has proposed a bill that covers the aggressive and controversial angles.

HB 2241 adds in mandatory minimum sentences and denies probation or parole to offenders convicted of possessing, using, selling, manufacturing or transporting heroin, fentanyl, carfentanil or fentanyl substitutes. The mandatory minimum sentence for the above would be five years, with a max of 15. A previous conviction involving those drugs would bump that minimum up to 10 years, topping out at 20 for a maximum sentence.

This is a tough stance taken on addicts and those who sell to them — but ignores the prescription opioid elephant in the room. According to the Journal of the American Medical Association, 75 percent of heroin users in treatment started their opioid journey with painkillers.

“If you were to possess or use heroin because you can’t get access to opioids because of your pain, then prison isn’t really going to help, is it?” Higgins said. “Maybe putting them all into one category is wrong.”

As such, opioids prescribed for pain are going to be harder to get, harder to hold onto, and harder to hide. Prescriptions for Schedule II drugs like opioids will be moved to a computerized system, to prevent forged prescriptions from being used to obtain painkillers. Additionally, limits will be placed on permitted dosages for opioids as well as for how long they can be prescribed for.

However, a one-size-fits-all legislative approach to medicine doesn’t jive well with those who represent caregivers in the state. The Arizona Medical Association advocates for medical professionals and took umbrage at Ducey legislatively tying the hands of doctors. The organization sent a letter to Dr. Cara Christ, director of the Arizona Department of Health Services, outlining their concerns.

In particular, ArMA warned of the unintended consequences of limiting prescriptions in terms of the damage it could do to vulnerable populations such as those unable to repeatedly visit a doctor or patients in rural communities. ArMA claims that the inflexibility of this law could burden doctors and patients alike.

The good news is that the governor’s plan offers them a way out: medically-assisted treatment, which is a combination of addiction drugs, counseling, and other health services. This is in part funded through AHCCCS, or Access — even if those requiring treatment aren’t a part of the program, funds are available to help them, as well.

“We need ready access to opioid medications,” Higgins said. “I’m a firm a believer in MAT.”

What remains to be seen is whether or not these initiatives will prove more effective than last year’s push to end opioid abuse — if carrots, sticks, and slaps on the wrist are enough to end opioid abuse in Arizona.

Erik Kolsrud is the Don Bolles Fellow covering the Legislature for Arizona Sonora News, a service provided by the school of journalism at the University of Arizona. Reach him at ekolsrud@email.arizona.edu.

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