As of January 1, 2018, the Controlled Substance Abuse Prevention Act will go into effect in Nevada, a law passed unanimously by both houses and officially signed in June of this year. The primary goal of the changes brought about by the legislation is to lower rates of opiate prescriptions, addiction, and overdose deaths.
Many of the changes focus on physicians who write prescriptions for controlled substances for patients. With the new law, they will be required to have a thorough conversation with their patients that ensures all receive the following information:
- A thorough investigation of all possible options for treatment that do not involve the use of addictive medications
- A detailed list of risks that can occur when taking painkillers and other controlled substances as well as the benefits, including the potential risks to an unborn child
- A point-by-point treatment plan that includes holistic options as well as initial low-dose use of the medication
- How to safely store medications so they are not tampered with by others
- How refills will be handled by the doctor’s office
- How to safely dispose of medications if there are leftover pills
- Whether or not it is advised to have naloxone on hand in the event of an unexpected overdose if the medication is an opiate painkiller
- Methods of detection of abuse for caregivers and parents of minors and dependent adults
The goal is to make sure that patients have all the information they need to make informed decisions and the structured support of doctors to continue making safe decisions throughout their use of these medications. Patients will be required to sign a written informed consent, and initially, doctors will only be able to prescribe 14 days’ worth of the controlled medication.
If pain management is required for longer than 30 days, both the prescribing physician and the patient must agree to a Prescription Medication Agreement that would be kept in the patient’s medical record and attached to the treatment plan. Among other things in this agreement, the standard will include such things as patient agreement to inform the prescribing doctor immediately if a problem develops or they begin to take another medication. The patient must also agree to never abuse the medication, sell it, or share it with others.
Should pain management treatment last longer than 90 days, the attention turns back to the prescribing physician. At this point, the doctor will need to:
- Assess whether or not the patient taking the medication is at risk of developing an abuse problem or currently abusing the drug.
- Reopen the dialogue with the patient regarding potential risks of continued use of the medications.
- Write an evidence-based diagnosis that articulates the reason for the ongoing medication and treatment decisions.
- Pull a copy of the patient’s report off the statewide prescription drug monitoring program to determine what other medications the patient is taking and if there is any abuse or negative interactions as a result. This must be repeated every 90 days throughout the course of treatment.
Under the new law, the length of time that a patient can continue to receive medication for pain management is 365 days, and while the goal of all of the changes is to protect patients, many are deeply upset by the extra “hoops” that they and their doctors will be required to jump through in the new year for legitimate pain management. Some feel that these tight restrictions cause doctors to limit the number of patients they will treat for issues like pain, and others feel they are treated like they are lying about their medical need in order to get pills.
It is difficult to find balance on this issue. Ultimately, it needs to protect those who are at risk of dying due to overdose or developing an addiction disorder but also ensure that patients who have a legitimate need for these medications have the access they require.
What do you think? Does the new Controlled Substance Abuse Prevention Act take things too far in Nevada? Will it result in many turning to street drugs to manage their pain and dying of an overdose anyway? Or is it the best possible way to protect the public from preventable death?