New Opioid Law Causes Confusion For Doctors

Aug 6, 2019

Florida lawmakers passed far-reaching health care legislation this year, from trying to import drugs from other countries to regulating plastic-surgery centers. 

But it’s another seemingly simple bill meant to prevent opioid abuse that is causing widespread confusion among physicians trying to figure out how to follow the law.

Staff members of the Florida Board of Medicine and physician organizations have been fielding questions from doctors about the broadly written bill, which was signed into law by Gov. Ron DeSantis in June.

But only the Florida Department of Health can provide details as to how the law will be interpreted.

As for now, the department isn’t talking.

Since July 1, physicians are supposed to have conversations with patients about opioid alternatives before providing anesthesia or prescribing, ordering, dispensing, or administering opioid drugs listed as what are known as Schedule II controlled substances.

Moreover, physicians are supposed to distribute a state-approved pamphlet on alternatives to opioids and document compliance with the law in patients’ medical records.

Jeff Scott, general counsel of the Florida Medical Association, sent a letter July 10 to Department of Health Secretary Scott Rivkees noting that the physicians’ organization has been barraged with questions that it cannot answer.

“Out of an abundance of caution the FMA is requesting the department’s interpretation,” Scott wrote in the letter.

One pressing question for the FMA is whether the mandate applies when a non-opioid based anesthesia such as Versed is used. The drug is used in colonoscopies.

“The purpose of HB 451 is to inform patients of the alternatives to opioids, with the hope that such information may eliminate the need for an opioid or reduce the amount of opioids used,” Scott wrote in his letter to Rivkees.

“Requiring a health care provider to provide this information when an opioid is not being prescribed, ordered or administered makes no sense,” he added.

Meanwhile, at a meeting last week in Coral Gables, Board of Medicine members agreed to alter disciplinary rules to ensure that physicians who run afoul of the new law pay fines for initial violations rather than face greater disciplinary actions.

The request was made by the FMA, according to Board of Medicine legal counsel Ed Tellechea.

The FMA, though, isn’t alone in its concerns about the new law and its implications.

Florida Board of Medicine member Sarvam TerKonda, a plastic surgeon at Mayo Clinic Jacksonville, said he knows that the new law has sparked questions at hospitals.

Also appearing at the meeting, Tallahassee attorney Allen Grossman told board members that there were errors in the initial opioid-alternative pamphlet that was approved by the Florida Department of Health, rendering the pamphlet ineffective.

Grossman, a former legal counsel for the Board of Medicine, asked the board to consider requesting that the Department of Health attend its next meeting in October.

Leaders of the Florida Society of Anesthesiologists also appeared at the meeting to share concerns with the law.

“We obviously want to do what’s best for our patients, but we also want to give our members and physician in the state some guidance,” said Florida Society of Anesthesiologists President Christian Diez.

Tellechea told Diez and the society’s vice president, Leopoldo Rodriguez, who also attended the board meeting, that a “strict application” of the law requires physicians to give every patient a Department of Health-approved pamphlet describing alternatives to opioids before putting the patients under.

Tellechea then quipped: “What are the alternatives? A shot of whiskey and a leather belt to bite down on?”

Board of Medicine member Hector Vila, though, said physicians shouldn’t overthink the new law.

“It’s the standard of care for all physicians that they should think about of opioid alternatives. So that’s part of it already,” said Vila, an anesthesiologist from Tampa.  “I don’t see this changing. Do what you’ve been doing. Practice good medicine and make sure somebody gives them the pamphlet.”