A range of views
Some physicians support the new rules, said Pete Wertheim, executive director of the Arizona Osteopathic Medical Association.
“For some, it has been a welcome relief,” he said. “They feel like it has given them an avenue, a means to confront patients.” Some doctors tell him it’s an opportunity to have a tough conversation with patients they believe to be at risk for addiction or overdose because of the medication.
The organization is striving to educate its members about Arizona’s prescribing rules and the exemptions. But, he said, most doctors now feel the message is clear: “We don’t want you prescribing opioids.”
Long before the law passed, Mr. Wertheim said, physicians were already telling him that they had stopped prescribing, because they “didn’t want the liability.”
He worries the current climate around prescribing will drive doctors out of pain management, especially in rural areas. There’s also a fear that some patients who can’t get prescription pills will try stronger street drugs, said Gerald Harris II, MD, an addiction treatment specialist in Glendale, Ariz.
Dr. Harris said he has seen an increase in referrals from doctors concerned that their patients with chronic pain are addicted to opioids. He receives new patients – almost daily, he said – whose physicians have stopped prescribing altogether.
“Their doctor is afraid and he’s cut them off,” Dr. Harris said. “Unfortunately, a great many patients turn to street heroin and other drugs to self-medicate because they couldn’t get the medications they need.”
Arizona’s Department of Health Services is working to reassure providers and dispel the myths, said Cara M. Christ, MD, who heads the agency and helped design the state’s opioid response. She pointed to the recently launched Opioid Assistance and Referral Line, created to help health care providers with complex cases. The state has also released a set of detailed prescribing guidelines for doctors.
Dr. Christ characterizes this as an “adjustment period” while physicians learn the new rules.
“The intent was never to stop prescribers from utilizing opioids,” she said. “It’s really meant to prevent a future generation from developing opioid use disorder, while not impacting current chronic pain patients.”
Dr. Christ said she just hasn’t heard of many patients losing access to medicine.
It’s still too early to gauge the law’s success, she said, but opioid prescriptions continue to decline in Arizona.
Arizona saw a 33% reduction in the number of opioid prescriptions in April, compared with the same period last year, state data show. Dr. Christ’s agency reports that more people are getting help for addiction: There has been about a 40% increase in hospitals referring patients for behavioral health treatment following an overdose.
Shannon Hubbard, the woman living with complex regional pain syndrome, considers herself fortunate that her doctors didn’t cut back her painkiller dose even more.
“I’m actually kind of lucky that I have such a severe case because at least they can’t say I’m crazy or it’s in my head,” she said.
Ms. Hubbard is well aware that people are dying every day from opioids. One of her family members struggles with heroin addiction, and she’s helping raise his daughter. But she’s adamant that there’s a better way to address the crisis.
“What they are doing is not working. They are having no effect on the guy who is on the street shooting heroin and is really in danger of overdosing,” she said. “Instead, they are hurting people that are actually helped by the drugs.”
This story is part of a partnership that includes KJZZ, NPR, and Kaiser Health News. Kaiser Health News is a nonprofit national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.