And welcome back to square off.
Four years ago,
Arizona cracked down on opioid abuse,
one of the targets doctors believed to be
writing prescriptions for too many pills,
but there was an unintended consequence.
People who suffer chronic pain said said they
could not get the medication they needed.
That's about to change.
A bill signed into law by Governor
Doug Ducey creates a carve out
for patients with chronic pain,
joining us to explain why the bill
was needed and who it can help is,
will humble executive director of the
Arizona Public Health Association.
Former Arizona Public health director
and one of the Champions of this bill.
Welcome back to square off morning grab.
The legislation was sponsored
by Senator Nancy Barto.
Why was it needed?
Well, I'll tell you
how it started.
She was just walking her district
like a lot of legislators do,
and she would run into one
person after the next.
That would say I got to tell you
about my daughter or my mom,
who really isn't intractable pain
and can't get the drugs that they
need to for the pain relief and.
If you do a root cause analysis,
it's goes back to the 2018 law which
for which had a limit on how much
you could prescribe of opioids of
it's called 90 ME but it but but
it if you if a doc was going to
prescribe more than 90 they needed
to do a consultation with another
doctor on a pain management doc
and that had a real 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 talk about fentanyl, right?
Well, fentanyl, but just
other prescriptions I work.
It seems like in 2019-2020
there was a real chill on
doctors prescribing right?
There's just a because of the
2018 law. There is a general chilling effect
within the physician community to say.
To to really to overreact to what
that law was intended to do and
and and you do see it reflected.
We do have fewer deaths from the
prescribed opioids after the 2018 law,
but we see fentanyl skyrocketing and
I think a lot of that or portion
of it at least is people who are
unable to get prescribed opioids
seeking relief from street fentanyl,
which is resulting in deaths.
So how will chronic pain
patients benefit from this law?
Yeah, so this is a really good law to, well.
Crafted puts in good guardrails to
provide people relief but without
opening the gates too far so there
needs to be a strong physician patient
relationship that's established before
you can prescribe over the 90 MME limit.
There's a there's a bunch of
guardrails in there to make sure
that it that it's working properly.
There's a clear definition of what kind
of pain qualifies and and by the way,
this the new law reflects
the new CDC guidance.
The old CDC guidance from 2018.
When the law was put together,
had that 90 ME cap and now CC
has removed that and this new
law reflects that change at CDC.
So it's interesting because I can
recall doing stories back in 2019.
Pain patients who formed their own
group they held rallies at the Capitol
saying we need some help here and here.
We are three years later,
and it's happening.
Is that the way it should work?
Well, that they have to wait three years?
Well no, they shouldn't have
to wait three years, but but
this bill shows it.
I think the way public policy should work,
maybe not as fast as it should,
but we had a big problem in 2018.
The law was passed.
It used best practices.
Now, four years later,
we're able to look at the data,
see what's actually happening,
and this is reflected.
This is kind of bill looks at the
unintended consequences of that
2018 law and make some adjustments.
And that's what public that's
what public policy should do is,
like we did this.
How's it working?
If it's not working in certain areas,
let's change it.
And that's what this law does.
And let's go back to the impact of that.
2018 bill numbers show it.
It did have an effect, correct,
right? So we see a lowering of
deaths from prescribed opioids,
but we see a skyrocketing,
skyrocketing number of
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 recreational use,
and it's such a powerful drug that
there's like no room for error on dosing,
but part of it is chronic,
intractable pain patients who can't
get prescriptions for opioids.
Looking for relief on the street and so
that's creating a feedback loop on the
fentanyl side and those deaths occurring,
and so we're hopeful that this will change
prescribing practices among physicians.
Make them more confident that they can
prescribe safely to their patients,
and these high need patients with
intractable pain can get some relief
that they're not getting right now.
So I think the fentanyl number of
deaths due to fentanyl is about
five to six times higher than
the rate. Of opioid, yes, it's
it's an exponential growth curve.
Is fentanyl immune from
any kind of public health?
It's a lot like this. Yeah, well,
this bill is gonna help.
I mean it, because we're it's gonna provide
a safety valve for people that really
need the pain so they don't have to seek.
The fentanyl on the street,
but it's a this is a big problem
because it's a, you know, it's it's it.
It's it's not you just can't change.
Prescribing practices it to get the the
fentanyl problem because it's a street drug.
So Senator Marsha's bill from a
couple of years ago which made the
test strips more widely available.
Christine Marsh of Christine Marsh.
The naloxone drugs that are
more widely available,
need to get distributed more effectively,
but it's a big problem and
not a single solution to it.
Right, we'll humble thank you
so much for joining us pleasure.