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.
