Arkansas is one of numerous states experiencing an alarming spike in deaths attributable to prescription pain killers.
A physician with the University of Arkansas for Medical Sciences, in a presentation to a legislative committee, said that changes in state law are needed in response to the statewide epidemic of abuse of drugs known as opioids. They include hydrocodone, oxycodone, morphine, codeine, heroin and fentanyl. According to news reports, the pop singer Prince died of an accidental overdose of fentanyl.
According to the Centers for Disease Control and Prevention, deaths due to overdoses of opioids have quadrupled in the past 15 years.
In 2011 the legislature created the Prescription Drug Monitoring Program, which became operational in 2013. It authorizes the state Health Department to collect information from physicians about the quantity of controlled substances they prescribe for patients.
In order to protect the confidentiality of patients, the 2011 law has numerous restrictions on who can access the data. For example, a law enforcement officer must obtain a warrant from a judge before being allowed to access the data, and to get the warrant the officer must show probable cause that information in the prescription drug data base would assist in the investigation of a crime.
Also, information in the drug monitoring program is not subject to subpoena or discovery in a civil lawsuit.
Act 1208 of 2015 enhanced the prescription drug monitoring program by allowing Health Department officials to review data to determine whether a physician is prescribing controlled substances "in a manner that may represent misuse or abuse of controlled substance."
The department may notify the state Medical Board of potential misuse or abuse.
The physician from UAMS said that the legislature should consider amending state law to allow officials of the Prescription Drug Monitoring Program to alert physicians about how their prescribing practices compare with other physicians. This would encourage physicians to prescribe fewer painkillers and opioids, even those who are not in any danger of over-prescribing.
The issue is delicate. Balanced against the rising number of deaths due to overdoses is the need to strongly protect a physician's autonomy. Medical professionals need to be assured they can take the necessary steps to treat their patients, without fear that law officers and bureaucrats will question their judgment. Protecting confidentiality is important because public opinion could easily jeopardize a physician's reputation and livelihood.
Another issue that medical professionals are carefully monitoring is the development of regulations by the state Medical Board to put in place Act 887 of 2015, which encourages the practice of telemedicine but with safeguards to protect patients' health.
The issue is whether a physician can examine and prescribe medications for a patient whom the physician has never examined in person. There are groups that believe audio and video technology is advanced to the point where a doctor should be able to prescribe drugs without having the patient in person. They say telemedicine can expand access to health care in isolated, rural areas.
On the other hand, symptoms may be overlooked if the physician doesn't perform an in-person exam. The Senate sponsor of telemedicine legislation said that the Board's rules appear to be a good compromise.