Testimony in Opposition to S.1092/H.3594 Before the Joint Committee on Mental Health Substance Use and Recovery

The Massachusetts Medical Society wishes to be recorded in opposition to S.1092/H.3594, “An Act relative to benzodiazepines and non-benzodiazepine hypnotics.” 

The Medical Society strongly supports the careful prescribing of benzodiazepines given concerns over addiction, over polypharmacy abuse with opioids, and given the clinical acuity of the detoxification process from benzodiazepines. Many of the continuing medical education courses that we provide free to all prescribers include modules on improving benzodiazepine prescribing. The MMS supports thoughtful safeguards to promote best practices and to eradicate any fraudulent prescribing of these and other drugs. However, the Medical Society also believes that benzodiazepines are essential drugs for the wellbeing of many patients, including those in recovery from alcoholism. At present, the proper tools exist to ensure proper prescribing, and we ultimately feel that S.1092/H.3594 will have a detrimental impact on care provided to patients.  

There are many ways that the standard of care in the practice of medicine is enforced in the Commonwealth. The Board of Registration in Medicine has a team of attorneys and investigators that continuously work to hold accountable those physicians who improperly prescribe. The Department of Public Health has a clinical advisory group that mines Prescription Monitoring Program Data to highlight cases for further review by licensing boards. The Office of the Attorney General, the tort system, and law enforcement all also have roles in maintaining best prescribing practices. Additionally, benzodiazepines are the only class of drugs, along with opioids, that are part of the explicit regulatory requirement that prescribers check the PMP before issuance of such a prescription to a patient for the first time. The MMS supports this current requirement.

Many of the specific provisions in this bill are problematic and will not result in the intended effect. The definition of non-benzodiazepine hypnotics is imprecise and has sufficient ambiguity to disallow any anticipation of its application. While the Medical Society appreciates the complexity of the medical discontinuation of benzodiazepines, protocols by the Department of Public Health are not the answer. The Department of Public Health does not have the clinical expertise as an entity such as the Board of Registration of Medicine, and the aforementioned existing safeguards are more than sufficient to promote best prescribing practices. A protocol-by-protocol approach to issues of public health concern is neither sustainable nor consistent with the long history of the provision of good medicine in Massachusetts.

The “brightly colored” paper provision contained in the Senate version of this bill is also problematic. In a time when we’re trying to destigmatize mental health issues and to promote recovery of diseases such as alcoholism, requiring recipients of benzodiazepines to have to present to the pharmacy with a scarlet letter would be antithetical to the improvements in mental health and substance abuse care over the past many years. It does not seem to provide a concrete solution to any issue and it’s yet another burden to prescribers.

The Medical Society continues to question the provision of the bill prohibiting short term benzodiazepine prescriptions. If the intent of the bill is to reduce this prescribing, why prohibit short-duration prescription? Such a provision will only lead to longer-duration prescriptions.

Lastly, the section requiring written informed consent is also problematic. Physicians make decisions on a daily basis about how best to provide informed consent. Many factors dictate how best to communicate medical information to a particular patient- what level of scientific detail should they provide on the risk and benefits, what types of alternatives are relevant to this particular case, and in what medium can the information best be conveyed? Written form is most effective in some instances and physicians will elect to utilize it. In others, a verbal discussion is more appropriate because of various factors (i.e., multiple informed consent forms signed or discussions had over the course of refills, literacy issues, or prioritization of time during a given clinical encounter.) 

The Medical Society supports the thoughtful prescribing of these complex medications. The Medical Society supports the intent to ensure that improper prescribers are held accountable and that patients are properly informed of the risks, benefits, and alternatives to benzodiazepines. But the Medical Society firmly opposes this bill, and believes that the specific policy provisions put forward in House 4062 will have a detrimental impact on the provision of care in the Commonwealth. The Medical Society asks you to reject S.1092/H.3594.

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