Political Advocacy Paper: House Bill 21: Controlled Substances
House Bill 21, or HB 21, is a house bill that was signed into law in March 2018, by Governer Rick Scott of Florida. HB 21 amends various sections of law to increase regulation, training, and proper reporting when providers prescribe and dispense a controlled substance. This bill sets a requirement on healthcare practitioners who prescribe controlled substances, specifically opioids, to their patients. This new law implemented requirements of continuing education for practitioners, accompanied by new penalties for the practitioners who are in noncompliance of the obligations. Practitioners, who are authorized to prescribe controlled substance and are registered with the DEA, will be required, starting January 2019, to participate in a 2-hour continuing education course on prescribing controlled substances, which must be renewed every two years.
Aditionally, there is a new definition for “acute pain” and what it means to prescribe a controlled substance for such, including a limited length of treatment using the prescribed substance. HB 21 defines acute pain as “the normal, predicted, physiological, and time limited response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute illness”. The new definition is accompanied with an arbitrary limit on amounts of opiods that is allowed to be prescribed as a form of treatment for acute pain, set to not exceed a three-day supply. On the contrary, a seven-day supply will be allowed under circumstances that if more than three days of substance treatment is necessary and if there is a lack of alternative treatment options. Alongside, practitioner will be required to include writing on the prescription note that it is an “exception” for the patient to receive a seven-day supply. Pain related to cancer or terminal conditions, and traumatic injuries scoring higher than “9” on the injury severity score, were exempt from the definition of acute pain. If the prescription was exempt due to the high score on the injury severity score, practitioners must aditionally prescribe an emergency opioid antagonist — which targets all Schedule II controlled substances, not just opioids. Furthermore, the three to seven day supply limit applies only to acute pain, not chronic nonmalignant pain. There are also new procedures with expectations to be followed prior to and after prescribing a controlled substance, by utilizing the Electronic Florida Online Reporting of Controlled Substances Evaluation Program (E-FORCSE), which is a Florida Prescription Drug Monitoring Program (PDMP). Prior to being allowed to prescribe a patient who is 16 years and older a controlled substance prescription, practitioners will be required to review the patient’s prescription history, through the PDMP. This is in efforts to decrease the patient having multiple active prescriptions for opioids from other health care providers. Should access to the program be limited to due technical errors, practitioners must document this in the patient’s record, or face penalties and disciplinary actions from the Board of Medicine.
In conjunction, HB 21 also targets the “pill mill” epidemic, which is a result from clinics that contributed to the drug trade by prescribing excessive amounts of opioid drugs. This epidemic originally created the PDMP, but practioners were previously not required to check and report prescriptions to the database, which HB 21 revised. HB 21 also provides appropriations for the Fiscal year of 2018-2019, including recurring funds towards Department of Children and Families (DCF) for community based services to address opioid crisis, including Medicated Asissted Treatments (MAT), funds towards the Department of Health (DOH) to purchase emergency opiod antagonists, MAT of substance abuse disorders related to criminal justice systems, and for imporvements to the PDMP documentation system. There will also be nonrecurring funds for expenditures relates to the second year of the State Targeted Response to the Opioid Crisis grant. The intent of this legislation is to combat the opioid crisis that has affected a significant amount of Floridians. According to the National Institute on Drug Abuse, in 2016 there were 2, 798 opioid-related deaths in Florida, and 1, 566 synthetic-opioid related deaths. Providers wrote an estimated 62. 8 per 100 persons opioid prescription in 2015 for Florida residents. According to the Center for Disease Control, or CDC, heroin has increased across the whole United States among men and women, most age groups, and all income levels. The goal is to prevent patient’s from getting addicted to prescription drugs, which can lead to the abuse of street drugs, including heroin and fentanyl. HB 21 further also provides continues services and treatment options for those facing substance use disorders, and are dependent on MAT to defeat their drug addiction.
House Bill 21 aligns with various NASW codes of ethics, including the ethical principle of “Social workers’ primary goal is to help people in need and to address social problems”. The opioid crisis is an important social problem that a social worker may face, as substance abuse is often intergrated within the field of social work, and the communities social workers work in, especially due to the current epidemic Floridians are faced with. Social Workers that are active clinicians, advocates, and even in macro practice observe the consequences of substance abuse such as interrupted family dynamics, institutionalization, overdoses, and even deaths. As all Social Workers are expected to be advocates for their clients and their communuties, it is expected that they address the opioid crisis and advocate for the appropriate steps to take, including support for HB 21, to decrease the crisis and its effects on our potential clients. Another code of ethics HB 21 aligns with is the ethical value of “Dignity and Worth of the Person”. As stated by the NASW, Social Workers “seek to resolve conflicts between clients' interests and the broader society's interests in a socially responsible manner consistent with the values, ethical principles, and ethical standards of the profession”.
HB 21 took measures in efforts to decrease the drug dependecy and opioid crisis that many individuals are involved with. This bill aimed to recognize that a person is worth more than a drug addiction and or opioid dependency, which now has a higher prospect of being prevented with implemented measures that have to be followed by practitioners. House Commerce Chairman, Jim Boyd, who is a Bradenton Republican, sponsored HB 21. Jim Boyd described this bill as “another step to curbing this epidemic”. Jim Boyd was able to recognize and acknowledge that although the bill won’t make the problem go away completely, he does believe it is a way for us to fight back. Jim Boyd has high ratings from various political positions, including Florida Health Care Association (FHCA), Foundation for Florida’s Future, Florida Chamber of Commerce, and the Americans for Prosperity- Florida. This is a totaling of more than $65 million dollars approved by Governor Rick Scott to support opioid treatment. Rick Scott, Governor of Florida, is a supporter of HB 21 as he signed this Bill into law earlier in 2018. Rick Scott is a Republican, who also endorsed President Donald Trump during the presidential election of 2016, as has President Trump endored Governor Scott during the Senate bid. Attorney General Pam Bondi is also a major supporter of HB 21 stating, “Florida continues to tackle the national opioid crisis” and that HB 21 will “help support state efforts and save lives”.
HB 21 had great legislative support, as members of the House Appropriations Committee unanimously voted in favor of the bill. The vote came to 99-0, showing there were no oppositions by members to pass HB 21. During the Legislative session, House Speaker Richard Corcoran, a Land O’ Lakes Republican, defended the bill’s approach, expressing that although it is an “inconvenience” for doctors and physicians, it is an “inconveniece worth saving 50, 000 lives nationwide”. Those opposing HB 21 were predominantly physicians, who objected during the Legislative Session. Dr. Hank Hutchinson, medical director of orthopedic trauma at Tallahassee Memorial Hospital opposed to HB 21, claiming “putting a strict day limit on prescriptions is really bad for our patients” and that his pateitns are going to face “hardships with this”. Hutchinson continued to state his opposition that having “legislators dictating how to practice medicine, I find very problematic…all it would take would be for two (lawmakers) to be involved in a trauma and they’d be like, ‘(Hutchinson) is right. ’” Hutchinson explained that he is employed at the region’s only orthopedic trauma center in Tallahassee, creating barriers for his out-of-town patients to have to visit his office weekly in order to continue receiving refills on their prescriptions. Florida Orthopaedic Society lobbyist, Toni Large, also expressed opposition to HB 21, claiming that the proposed measures goes “a step too far”. He expressed that “My orthopedic surgeons want you all to understand that when you go back after this bill passes that you are going to have patients and loved ones and constituents that we are no longer going be able to effectively manage their pain. And we don’t want you to vote on this bill today without us getting that message across”. The goal of Large was to inform House members of the limitations patient’s may face with this bill being implemented, including a possible decrease of individuals seeking out orthopedic surgeons as the prescription limit will conribute to that. She expressed that it is already hard to see a surgeon, and this bill would make it “twice as hard”. After one month of HB 21 gone into effect, in August the Florida Department of Health (DOH) launched an awareness campaign. The Take Control campaign focused on controlled substances, utilizing characterisitcs apart of HB 21. The campaign was in efforts to “address the opioid crisis by limiting the risk of overprescribing for acute pain, and it will not impact patients who have established a treatment plan with their doctor that successfully manages their chronic debilitating pain”.
The campaign was launched in a website form allowing patients to access the portals with any FAQ’s, information, and resources for those who might be facing substance misuse, as well as resources for doctors to obtain their required continuing education credits. DCF will benefit from HB 21, as many funds are included towards DCF services within the bill. According to the bill, “27, 035, 532 in nonrecurring funds is appropriated from the Federal Grants Trust Fund to the Department of Children and Families (DCF) for expenditures related to the second year of the State Targeted Response to the Opioid Crisis grant. Additionally, $14, 626, 911 in recurring general revenue funds is appropriated to the DCF for community-based services to address the opioid crisis, including, but not limited to MAT”.
The Manatee Sheriff’s Office is also in support of HB 21, as they joined Governor Rick Scott in recognizing the funding and legislation. Manatee County Sherrif Rick Wells mentioned that HB 21 will assisst deputies and partners in the community to continously combat national opioid epidemics present in Florida. There is continuous work to ensure families have the resources needed to be successful in the battle against the crisis.
Many are in support of it considering the vote was 99-0. Those who were opposed to the bill were mainly doctors and surgeons, who may potentially lose income, and create an inconvenience, because of these restrictions and face penalties if orders are not correctly followed. Identification of coalitions, special interest groups, organizations; in depth review of findings regarding their positions. Analysis of the influential power of both support and opposition positions and potential of either passage or defeat of the bill.
