TESTIMONY OF THE MAINE MEDICAL ASSOCIATION

IN OPPOSITION TO

L.D. 1666, AN ACT TO REQUIRE CERTAIN HEALTH CARE PROVIDERS TO PROVIDE PATIENTS DETAILED INFORMATION ON THE RISKS ASSOCIATED WITH THE USE OF OPIOID MEDICATIONS AND SCHEDULE II DRUGS

Joint Standing Committee on Health Coverage, Insurance & Financial Services
Room 220, Cross State Office Building, Augusta, Maine
Wednesday, May 8, 2019, 2:00 p.m.

Good afternoon Senator Sanborn, Representative Tepler, and Members of the Joint Standing Committee on Health Coverage, Insurance & Financial Services.  I am Andrew MacLean, Interim CEO of the Maine Medical Association, and I am here today to testify in opposition to L.D. 1666, An Act to Require Certain Health Care Providers to Provide Patients Detailed Information on the Risks Associated with the Use of Opioid Medications and Schedule II Drugs.

The MMA is a professional organization representing more than 4300 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens.

The Maine legislature, executive agencies, and health care organizations have been developing public policy responses to the prescription and illicit drug use disorder problem in Maine since the emergence of Oxycontin on the market in the late 1990s/early 2000s.  The MMA and other clinician organizations have acknowledged the role of over-prescribing in contributing to the problem and have made it a priority to educate our members about appropriate prescribing of these drugs.  As we have presented in previous testimony on opioid bills during this session (MMA’s Maine Independent Clinical Information Service), the data demonstrate that these initiatives have resulted in a substantial reduction in opioid prescribing in Maine – among the states in the country with the most dramatic reduction.

While well-intentioned, MMA sees L.D. 1666 as proposing requirements that are duplicative of current legal and ethical standards in opioid prescribing and, while contributing nothing of substantive value to those standards, will further complicate the administrative burden of compliance with the existing standards.  The MMA urges the Committee not to pursue further legislation in this area.

The bill proposes specific requirements for obtaining “informed consent” to opioid treatment.  Because of the additional administrative burden of compliance with varying standards of informed consent, MMA always has cautioned the legislature against codifying in statute, differing standards for informed consent depending on disease, treatment modality, or part of the body, all of which have been the subject of such bills in past legislatures.  The concept of “informed consent” is well-settled in the ethical standards and common law governing the practice of medicine.  For example, I would draw the Committee’s attention to Code of Medical Ethics Opinion 2.1.1, Informed Consent, https://policysearch.ama-assn.org/policyfinder/detail/informed%20consent?uri=%2FAMADoc%2FEthics.xml-E-2.1.1.xml.  Also, two early cases on the law of informed consent are Schloendorff v. Society of New York Hospital, 211 N.Y. 125, 105 N.E. 92 (1914) and Salgo v. Leland Stanford Jr. University Board of Trustees, 317 P.2d 170 (1957).  Moreover, the Maine Board of Licensure in Medicine has issued Guidelines on Informed Consent:  https://www.maine.gov/md/laws-statutes/policies/INFORMED%20CONSENT.pdf.

The Maine legislature and executive branch agencies have been creating law governing the prescribing of controlled substances since the late 1990s, first by establishing the Controlled Substances Prescription Monitoring Program (PMP) and MDEA Rule Chapter 1 on standards for Schedule II prescriptions.  The two physician licensing boards have had rulemaking guidance on the use of controlled substances for the treatment of pain since 1999.  The Maine legislature enacted substantial restrictions on the prescription of opioid medications in P.L. 2015, Chapter 488, as amended by P.L. 2017, Chapter 213.  This legislation prompted in turn, Maine DHHS to promulgate OSAMHS Rule Chapter 11, Rules Governing the Controlled Substances Prescription Monitoring Program and Prescription of Opioid Medications and amendments to Joint Rule Chapter 21, Use of Controlled Substances for the Treatment of Pain (of the two physician licensing boards and the nursing board).  The legislature also has enacted P.L. 2017, Chapter 186 requiring all health care entities employing prescribers of opioid medications to have an opioid policy addressing, among other matters, informed consent to treatment with opioid medications.  L.D. 1666 does not contribute anything meaningful to this already comprehensive regulatory framework for opioid prescribing.

Thank you for considering the views of the MMA on L.D. 1666.  We would urge an “ought not to pass” vote on the bill.  I am happy to respond to any questions you may have.