President’s letter: The back story: A tremendous amount of behind-the-scenes work goes into the proc

Sunday, July 01, 2018 12:05 PM

by M. Robert Yakely, MD, President, Colorado Medical Society

When the Colorado General Assembly enacts a new law, the common misperception is that the passage of this legislation can always be traced as a linear lesson in civics. The back story of course is far more complex, intimately human, and evolves over time. This was certainly true for the recent bill aimed at helping to combat the opioid crisis by limiting opioid prescriptions.

The 2018 legislative story to address the public health crisis caused by opioid abuse and misuse actually began in 2012, when Governor John Hickenlooper, as part of a multi-state National Governors Association initiative, appointed a multi-stakeholder collaboration to develop a Colorado response. CMS immediately signed on in support and convened a  broad group of specialists to advise CMS policy and to collaborate with the governor, state agencies and legislative leaders. In terms of state legislative policy over the past six years, there has been, and will continue to be, a candid give-and-take conversation between our profession and the policy makers who ultimately pass laws and oversee their implementation. This is the crux of any good piece of public policy.

As SB 22, Measures for Safer Opioid Prescribing, went through the legislative process this year, there were diversions and misdirections. When our colleagues suggested exceptions for obvious circumstances, such as chronic pain that typically lasts longer than 90 days, for patients with cancer and those who are experiencing cancer-related pain, or patients undergoing palliative or hospice care, The Denver Post called them “loopholes.” The bill sponsors however understood the meaning of medical necessity and the suggestions were adopted and sustained. When plaintiff attorneys arrived late to this half-decade effort with an attempt to open up the Prescription Drug Monitoring Program report card database for fishing expeditions, legislators held fast to the notion that the means by which doctors learn from varied patterns of treatment are often complex and must remain a learning tool, not a courtroom exercise.

Unsung partners, the lobbyists suffer innumerable indignities on our behalf, performing heroics when making our case to antagonistic stakeholders. Their effectiveness ultimately comes from a combination of expertise in the legislative process and a methodical participation from our grassroots physician efforts. They engage physician activists from local communities who know their legislators and help staff our policy and real-world frontline committees and work groups. Over time, a threshold level of expertise and pragmatism settles into these deliberations, as good ideas are sifted from the bad.

One commendable manifestation of reaching that threshold: The body of law mandating prescription fill limits and PDMP checks will expire in three years. To the credit of the bill sponsors, they will see these three years through with us, monitoring and discussing the data as it evolves with our real-world experts, studying outcomes from other states, and eventually settling in once again on what will work best in the future. It is a tribute to our involved experts, our advocates and our legislators that evidence-based policy was chosen over ideology.