Key Assemblyman Resists Mandated Doctor-Patient Talks About Opioid Dangers

Andrew Kitchenman | December 4, 2015 | Health Care
Activists focus efforts on new bill aimed at children, but chances are slim without committee chairman’s support

A senior state legislator who exerts great influence on healthcare issues is being accused by drug-treatment advocates of causing a bottleneck that’s blocking a bill that requires informing patients of the risks of opioid addiction.

The issue is at the center of a wrenching debate in the closing weeks of a New Jersey legislative session over opioid -addiction legislation that at this point seems unlikely to come to a point due to opposition by Assemblyman Herb Conaway Jr.

As chairman of the Assembly Health and Senior Services Committee, Conaway sets the agenda for which healthcare-focused bills are debated in the chamber. While advocates for the legislation say that a mandate is urgently needed to save young people’s lives, Conaway says that inserting government mandates into the doctor-patient relationship would undermine a key principle in healthcare.

While advocates for mandated discussions have called for broader legislation that would affect all patients who are prescribed opioids, their recent efforts have focused on a new bill — A-4760, sponsored by Assemblyman Joseph A. Lagana (D-Bergen and Passaic) — that would provide addiction-risk information to the parents or guardians of any child prescribed opioids. The doctor would have the conversation with the child if the child has been legally emancipated, under the bill.

Elaine Pozycki
“Dr. Conaway, I implore you to post this bill, and stop preventing New Jersey parents from becoming informed about the addictive qualities of the medicine their children are being prescribed,” said Elaine Pozycki, co-chairwoman of the partnership, at a State House press conference yesterday. Her son Steven died as a result of a heroin addiction at age 32.

Under the bill, the healthcare provider would be required to obtain a signed acknowledgement that the discussion of addiction risk took place. The guidelines for the discussions would be written by the state Division of Consumer Affairs, part of the state Department of Law and Public Safety.

While opioid overdoses are highest among young adults in their 20s and 30s, opioid prescriptions given to elementary- and high-school students have been linked to an increased risk of illegal drug use among young adults.

Conaway said that reducing drug addiction is a priority for him, and that doctors should discuss the risks of any medications with patients. But this should be done on an individual basis, and not based on a government mandate, said Conaway, an internal-medicine doctor.

“The concerns that I have deal with intrusions by the government in the doctor-patient relationship,” Conaway said. “That relationship is critical to patients receiving the care they need. It’s critical to good outcomes in healthcare.”

Conaway called the doctor-patient relationship “sacrosanct” and said he has grave concerns about “interfering in one of the foundational tenets of healthcare provision.”

Conaway added that all doctors are trained to talk about the benefits and risks of medications with patients.

He likened the argument that the government should intrude in the doctor-patient relationship to reach a desired outcome to arguing that protections against illegal searches should be eliminated to reduce crime.

“Just because a goal is good, doesn’t mean we ought to be prepared to put aside first principles,” Conaway said.

He added that he was concerned that if this bill was enacted, then legislators would call for laws requiring doctors to talk about other topics with their patients. He recalled national debates over whether doctors should be required to use certain language when discussing abortion with patients.

Conaway said public education and awareness are most important in the fight against misuse of opioids.

He also expressed wariness about taking steps that would make it more difficult to prescribe opioids to patients with chronic pain.

“For decades, chronic pain was an unrecognized and untreated problem, and people suffered – unable to work, unable to interact with their family, unable to really enjoy their life – because the medical community basically ignored the problem of chronic pain,” Conaway said.

[related]The doctor-patient discussion mandate drew support from three Assembly members – Marlene Caride (D-Bergen and Passaic), Patricia Egan Jones (D-Camden and Gloucester), and Patrick J. Diegnan Jr. (D-Middlesex).

Jones said her experience as the Camden County surrogate – which required her to learn the cause of residents’ death in order to handle their wills – brought her into contact with many families who lost members to overdoses. Caride said her work as a municipal prosecutor showed her the extent of the problem. And Diegnan cited the example of constituents who’ve lost family members.

“Why in the world is it taking so long for common-sense legislation to become law?” Diegnan asked.

Dr. Andrew Kolodny, chief medical officer of New York-based addiction treatment center Phoenix House, noted that drug overdoses have mirrored the increase in opioid prescriptions. This rapid increase began after Purdue Pharma introduced OxyContin in 1996 and advertised that prescription opioids are safe, Kolodny said. Overdose deaths have reached new record highs annually for the past 15 years.

Partnership for a Drug-Free New Jersey Executive Director Angelo M. Valente said it’s “crucial” for the Legislature to pass either the bill focused on children or an alternative, such as a bill sponsored by Conaway himself last year that would require healthcare providers to inform patients of the potential of addiction. Conaway hasn’t scheduled that bill for a hearing since introducing it in September 2014.