THE STATE HOUSE — The House and Senate on Thursday broke through an impasse over a bill intended to crack down on prescription drug abuse and more closely monitor the way prescriptions are dispensed in Massachusetts.
The bill attempts to limit the number of doctors who excessively prescribe medications that can be abused or sold illegally, and attempts to increase participation in the state’s Prescription Monitoring Program that can be used to identify patients who might be shopping for prescription from various doctors.
After sitting idle for more than six months, the bill sponsored by Sen. John Keenan of Quincy began advancing in the House during the final days of formal sessions last week. And though work on the bill was not completed before formal deliberations ended, enough progress was made to allow the branches to enact and send the bill to Gov. Deval Patrick on Thursday during lightly attended informal sessions.
“I don’t think there’s anything objectionable in there. I think they’re reasonable, rationale and practical steps and we’re hopeful that he will sign it,” Keenan said, referring to Patrick.
Keenan added, “I think it will work to stem the flow of prescription painkillers. More than anything else it’s heightened awareness with the public and the medical community.”
Under the bill, participation in the state’s prescription monitoring program by doctors who prescribe controlled substances would become mandatory, rather than voluntary, and MassHealth patients who fill 11 prescriptions from four doctors or at four different pharmacies within 90 days would be put on a watch list.
“As we progress toward electronic medical records, what we’ve put in place will lead to the discussion of making sure prescriptions are included in electronic medical records as part of the overall patient profile and available to physicians,” Keenan said.
The Senate ultimately agreed to changes recommended by House leadership that would automatically enroll physicians in the state’s Prescription Monitoring Program when they renew their medical license, eliminating what some doctors described as a “cumbersome process” of paper applications.
The final bill dropped a Senate-proposed requirement that doctors consult the prescription monitoring database before prescribing painkillers to a patient for the first time. With the compromise, doctors would only be required to consult the PMP for new patients, a provision the bill’s authors believe will cut down on doctor shopping for prescriptions.
Under the bill, pharmacies would be prohibited from filling prescriptions for narcotics unless written by a doctor licensed and registered in-state, or in one of the five contiguous states to Massachusetts and Maine.
The Massachusetts Medical Society last week dropped its concerns about the bill, and endorsed the House changes around automatic enrollment that the society said would address the low levels of involvement with the program. Currently, only 1,800 prescribers out of nearly 40,000 in the state have registered for the monitoring program.
Doctors had also expressed concern about how the mandatory use of the prescription monitoring program could infringe on long-standing relationships between patients and doctors, an issue that was addressed with the changes adopted Thursday.
During the bill’s path to final passage, a ban on the designer drug known as “bath salts” became a pawn in negotiations between the House and Senate even though both branches supported the ban on the addictive stimulant that people either snort or smoke. The ban was included in the final bill.
By making “bath salts” a Class C controlled substance, the bill gives police the tools they need to fight the new crop of drugs that are sold legally over the counter in head shops and some convenience stores, as well as on the internet, according to Rep. George Ross, the freshman Republican from Attleboro who fought for the ban.
“This was really a public safety issue,” Ross said after the bill passed in the House. “This takes a very dangerous group of drugs off the streets now.”
The drug has been shown in medical studies to cause lasting damage to users and cause paranoia. It has also been linked to several violent incidents around the country, Ross argued when pushing to outlaw the drug. Ross, who managed to include a bath salts ban in other pieces of legislation, expressed relief that it has reached the governor.
“I’m pleased it is finally over,” Ross said Thursday after it passed.
Under the bill, pharmacies and drug manufacturers would be required to report drug thefts to local or state police, as well as the Drug Enforcement Agency, and prescriptions for controlled substances would have to be written by doctors on “secure,” tamper-proof prescription pads already required for Medicare and Medicaid patients.
Pharmacies will still be required to sell drug lockboxes, but they will only have to advertise them near registers, the Department of Public Health will have to provide patient information on the dangers of Class II and Class III drugs, and a working group of physicians will be tapped to write a “best practices” guide for prescribing opioids.