The State Will See You Now by Pat Conrad MD

One can’t make jokes in medicine – or practically anywhere – for fear that the absurd will become reality.  The government of my beloved Sunshine State already has a burdensome licensing process, and a Board of Medicine whose members could use 23andMe to trace lineage to the Spanish Inquisition.  And now they’ve found a new way up the ass of their physician-servant class:  opioid abuse.  Amplified by the ridiculous blather about drugs from the White House and AG Sessions, the “OPIOID CRISIS” will now stop the misbehavior of some by punishing the many.

HB 21 has been passed by a bunch of Tallahassee politicians, signed by a governor who made tens of millions as the head of HCA (and left in the swirl of a Medicare/Medicaid fraud settlement), all of whom claim they have consulted doctors to find the best way to curb opioid abuse.

Sure they did.  My gut tells me that the politicians told the Florida Medical Association the way it was going to be, and ensured that the doctors consulted were the ones most friendly to government solutions.  You can look at the FMA website here to read all the goodies, which involve blowing $50 million in taxpayer money on drug treatment centers, clinic monitoring, and more law enforcement.  Another bad waste of good money that will create more parasitic, “vital” state jobs.

The new law reaffirms the definition of acute pain, and caps what a physician may prescribe at a 3-day supply; for an exception, the doc has to write “ACUTE PAIN EXCEPTION”, and document “the lack of alternative treatment options that justify deviation,” and then you can go up to seven days.

For added fun, an Injury Severity Score of 9 or greater requires concurrent prescription of an “emergency opioid antagonist.”  So on the Injury Severity Scale, any pain meds prescribed for a femur fracture also means some Narcan.  This is tantamount to saying to the post-trauma patient:  “I know you really need some pain medication, and I also think there is a significant risk you will abuse it, so hopefully someone will find this injectable or nasal spray on the nightstand if you look a little blue.”  That is going to play really, really well in deposition.

The wry joke I heard some months ago was that eventually the politicians would make us check the drug data base on every patient every time.  Well it’s no joke as of July 1, at which point I shall be required to check the state drug database every single time I write ANY controlled prescription for any patient 16 and older.  The state was already monitoring every controlled script by writer and recipient, information with which it could have done anything to either party; now it is monitoring physician awareness and adherence.  There are of course penalties for disobedience:  “It should be noted that the DOH is required to issue a non-disciplinary citation to any prescriber or dispenser who fails to consult the database prior to prescribing or dispensing a controlled substance. For each subsequent offense, a practitioner is subject to discipline from their respective board.”

Florida’s war on opioids is of course, a proxy assault on physician autonomy disguised as protecting patients.  Sure it may reduce some street availability, which I am confident can be made up by Mexican fentanyl.  It might clean some truly sleazy docs off the market, which is fine.  But in the grade school logic applied by governments everywhere, those two noisy brats in the back mean no recess for the rest of us.  I am one of the most tight-fisted narcotic prescribers I know.  Drug seekers literally see my truck in the parking lot and head to another ER.  But my state government just told me that, in the interest of protecting innocent patients and dirtball druggies, my quarter century of training and experience counts for shit.  I am not to be trusted, and need to enthusiastically embrace prescribed solutions as fast as I can take the mandatory, fee applicable 2-hour opioid awareness CME as a condition for continued licensure.  I am the problem, and I will be fixed.

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116930cookie-checkThe State Will See You Now by Pat Conrad MD