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Despite garnering opposition from healthcare providers, a new state law requiring opioid agreements went into effect last month.

In 2018, 12 Pennsylvanians died every day of a drug-related overdose.

To address these dire statistics and help prevent opioid addiction, Gov. Tom Wolf recently signed into law new guidelines that require doctors and certain patients enter into a written agreement before prescribing any opioid medications. 

Senate Bill 572, now Pennsylvania Act 112 Of 2019, stipulates that before patients receive new opioid prescriptions, they must sign a contract with their provider stating they understand the goals of the treatment and the associated risks, and that they consent to periodic drug testing to ensure they aren’t misusing them. 

According to the text of the law, patients who enter into these agreements are also:

  • required to take the prescription opioid medication as instructed
  • prohibited from sharing the medication with other people
  • required to tell their provider about any other controlled substances they’ve been prescribed or taken 

The rules are based on guidelines issued by the Centers for Disease Control and Prevention for prescribing opioids for chronic pain—which, incidentally, don’t mention written contracts—as well as the state Department of Health’s own prescribing guidelines for patients dealing with pain not related to cancer. Individuals who need prescription painkillers due to a medical emergency, cancer, or for use in palliative or hospice care are exempt from the law. 

While the legislation is not a “silver bullet” in the state’s efforts to address opioid addiction, bill sponsor Sen. Ryan Aument (R-36) said that it “is still a vital piece of the puzzle to prevent more needless deaths in our communities.”

“For many victims, addiction did not begin in dark alleys or drug dens,” Aument pointed out. “Instead, it started in the relative safety of a doctor’s office, with a legal prescription that was misused, beginning a downward spiral into chemical dependence and criminal activity.”

Those who opposed the new law have raised concerns about interfering in the relationship between a prescriber and patient. As a spokesperson for the Pennsylvania Medical Society said in a recent interview: “Medicine isn’t like following a cookbook. Everything is different and you have to individualize treatment.” 

Patient advocates also worry that legislation like this conflates individuals who have opioid use disorder with chronic pain sufferers—thus making it harder for them to get the help they need. 

“It’s bad news all the way around,” Terri Lewis, a chronic pain advocate, told The Appeal.

Since the early 1980s, experts have advocated for opioid treatment agreements—also known as pain or narcotic contracts—as one mechanism for addressing addiction, according to a review published in the Cleveland Clinic Journal of Medicine recently. While the paper’s authors say agreements are, if worded properly, “an important tool in chronic pain management,” they also point out potential harms. 

“Although no studies have systematically assessed the style and tone of available treatment agreements, many of the agreements seem to stigmatize the patient, using language that is mistrustful, accusatory, and even confrontational and that implies that the patient will misuse or abuse the medications,” the authors write. “Such language defeats attempts to communicate openly and implies a deprecatory attitude towards patients. Stigmatization may result in undertreatment of pain, physician refusal to prescribe opioids, and patient refusal to submit to the terms of a one-sided agreement perceived as unfair.”

Pennsylvania’s new law took effect in November, and joins New Hampshire and Massachusetts, where opioid written agreements are also required by law.

According to a recent report from the Drug Enforcement Administration, drug-related overdose deaths in Pennsylvania—most of which involve fentanyl—decreased by 18 percent between 2017 and 2018. Last year, Gov. Wolf signed the state’s Opioid Disaster Declaration so resources could be directed to better address the opioid crisis; the declaration has since been renewed eight times.