New Arizona law provides relief to chronic-pain patients

and welcome back to the showdown Four years ago, Arizona cracked down on opioid abuse. One target, doctors believed, was prescribing too many pills, but there was an unintended consequence. People suffering from

chronic

pain

said they couldn't get the medications they needed. that's about to change a bill signed into law by governor doug ducey creates an exception for

chronic

pain

patients

joining us to explain why the bill was necessary and who it can help is will humble executive director of

arizona

public health association former

arizona

public health director and one of the proponents of this bill welcome back to face us tomorrow brad the legislation was sponsored by senator nancy bartow why was it necessary?

Well, I'll tell you how it started. She was simply walking around her district like many legislators. do and she would run into person after person who would say: I have to tell you about my daughter or my mom who really has treatable pain and they can't get the medications they need to relieve the pain and if you do an analysis of the cause The root goes back to the 2018 law, which had a limit on the amount of opioids that could be prescribed, it's called 90 mme, but if a doctor was going to prescribe more than 90, they had to do so. a consultation with another doctor, um in a pain management dock, and that had a really chilling effect on people being able to get

relief

and also a chilling effect on other prescriptions that weren't necessarily opioids, yeah, that's right, and well I think one of you is talking about fentanyl, well fentanyl, but just other prescriptions, it seems like in 2019, 2020 there was a real chill among prescribing doctors, but because of the 2018 law, there is a general chilling effect within the medical community to say, uh, really, overreact to what that law was intended to do and it's reflected, we have fewer deaths from prescription opioids after the 2018 law, but we see fentanyl skyrocketing and I think a lot of that, or at least some of it, is people not being able to prescribe opioids and seeking

relief

from street fentanyl, which is causing deaths, so how are chronic pain

patients

going to benefit from this law?

Yes, this is a really good law that puts up good guardrails to provide relief to people, but without opening the doors. too far, so a strong doctor-patient relationship needs to be established before you can prescribe above the 90 mme limit. There are plenty of rails to make sure it's working properly. There is a clear definition of what type of pain qualifies and, by the way, this, the new law reflects the new CDC guidance, the old CDC guidance from 2018, when the law was made, had that limit of 90 mme and now, cc, has eliminated it and this new law reflects that. change at the cdc so it's interesting because I remember doing stories in 2019, pain patients forming their own group, holding rallies at the capitol saying we need help here and here we are three years later and it's happening is the way should work fine, they have to wait three years, well, no, they shouldn't have to wait three years, but this bill shows that I think the way public policy should work is maybe not as fast as it should be, but we had a big problem in 2018.

The law was passed, it used best practices now, four years later, we can look at the data, see what is really happening and this reflects that this is a type of bill that looks at the consequences not desired of that 2018 law and makes some adjustments and that's what the public that's what public policy should do is how we did this, how does it work? If it doesn't work in certain areas, let's change it and that's what this law does and go back to the impact of that 2018 bill. The numbers show that it did have an effect. right, so we see a reduction in deaths from prescription opioids, but we see a skyrocketing number of deaths from fentanyl and that's a combination of a couple, it's a street drug for the most part, a lot of that is use recreational and it is a powerful medication where there is no margin for error in dosing, but part of this is patients with chronic intractable pain who cannot get opioid prescriptions and are seeking relief on the streets, which is creating a feedback loop on the fentanyl side and the deaths that occur and so we are hopeful that this will change prescribing practices among physicians, make them more confident that they can prescribe safely to their patients and that these high-need patients and intractable pain can get relief that they're not getting right now, so I think that fentanyl The number of deaths due to fentanyl is five to six times the rate of opioids.

It is an exponential growth curve. Is fentanyl immune to any type of public health? It's very similar to this. Yeah, well, this bill is going to help. I'm serious because it's going to provide a safety valve for people who really need the pain so they don't have to look for fentanyl on the street, but it's a big problem because it's a problem, you know, no, you just can't . Not changing prescribing practices to address the fentanyl problem because it is a street drug, which is why a bill from Senator Marsha from a couple of years ago that made test strips more available is needed. to distribute it more effectively, but it is a big problem and there is no single solution.

Very good, thank you very much for joining us.