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Hospice Doctors Seek Exemption From Drug Database

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
National Institutes of Health
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Less than a year after the Florida Legislature passed a sweeping bill that requires physicians to check a statewide database before ordering opioids for patients, lawmakers are being asked to consider an exemption for doctors who care for dying people.

It’s not because the requirement is burdensome for the doctors, said Stephen Leedy, a board-certified hospice and palliative care physician. Instead, it’s because checking the prescription-drug database each time controlled substances are ordered for dying people leads to delays, causing the patients to unnecessarily suffer at the end of life, he said.

The requirement for physicians to check the database is aimed, at least in part, at preventing drug abusers from “doctor shopping” to improperly get controlled substances.

“We feel hospice and palliative care providers do not contribute to the diversion problem within the state of Florida, and hospice patients do not either,” Leedy told members of the Senate Health Policy Committee on Monday.

Leedy said Florida had 137,000 hospice patients last year. On average, they were in hospice for three weeks before dying.

“During those three weeks, these patients were not out there ‘doctor shopping.’ They were not out there looking for opioids in the streets. They were mainly bed-bound and in pain, short of breath, being managed by hospice providers,” he said. “These are not patients that are at risk of going out there doing things that we don’t want them to do.”

Moreover, Leedy testified that it’s not unusual for a physician to adjust pain medications six or seven times within the first three days of a patient arriving at a hospice. Each time a change is made, the physician has to check the database.

“You can imagine if you do the math and think about it, how ridiculous this process becomes after a while in terms of the number of queries that need to be done,” he said.

The Legislature made a priority last year of trying to take steps to combat addiction to prescription painkillers, which can lead to people abusing street drugs such as heroin and fentanyl.

Lawmakers approved a bill that requires physicians or their staff members to check with a statewide database before prescribing or dispensing drugs. The bill also imposes a three-day limit on prescriptions for treatment of acute pain. Physicians can prescribe up to seven-day supplies of controlled substances if deemed medically necessary.

While the legislation exempted hospice and palliative care patients from the prescription limits, the bill did not exempt the physicians who treat those patients from having to query the database. The Florida Hospice and Palliative Care Association is asking that the Legislature exempt the physicians from having to query the database altogether or require them to check it only when patients are admitted.

Paul Ledford, president of the Florida Hospice and Palliative Care Association, said his association was looking for lawmakers to sponsor such a bill but hasn’t found any yet.

But Senate Health Policy Chairwoman Gayle Harrell, R-Stuart, told Leedy that she understood his message and that “we’ll look into it,”

The Health Policy Committee on Monday received an overview of the 2018 law and the effect it has had on prescribing in Florida.

According to Rebecca Poston, manager of the state’s prescription-drug monitoring program, there has been a 3.8 percent reduction in the number of patients receiving controlled substances in Florida. Also, there has been a 4.6 percent decrease in controlled-substance prescriptions dispensed

Leedy stressed to the committee that physicians support efforts to address opioid abuse but said it doesn’t necessarily make sense to require the database queries when patients are dying in hospice programs.

One Florida hospice had queried the prescription-drug monitoring program 180,000 times since the law passed, Leedy said. The queries resulted in finding one patient who had doctor-shopped for painkillers.

“That patient was actively dying at the moment, and the fact they had doctor-shopped previously was not truly relative to the  patient’s situation,” he said.