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SVS responds to opioid crisis bill

Opioid crisis bill meets muster with SVS legislative liaisons

WASHINGTON, D.C., Oct. 25, 2018 – Vascular surgeons overall are pleased with the passage of comprehensive legislation designed to fight the opioid crisis. President Donald J. Trump signed the law, for which the SVS actively lobbied Congress, on Wednesday.

The SUPPORT (Substance Use-Disorder Prevention that Promote Opioid Recovery and Treatment) for Patients and Communities Act received overwhelming approval in both chambers of Congress.

“We are very supportive of efforts to find solutions to the opioid crisis, including this bill, and appreciative of the extensive dialogue and negotiations that went into the final package,” said Dr. Megan Tracci, chair of the SVS Government Relations Committee.

“For the surgical community and our patients, some of what is significant about this bill is what is not in there at all. What we aren’t seeing are once-size-fits-all requirements, such as a broad characterization of pain or days of prescription. As surgeons, we deal with complex patients and it can be difficult to come up with a pain control regimen for these patients, especially those recovering from open aortic operations, some lower extremity cases, and amputations.”

Dr. Anahita Dua, a second year vascular fellow at Stanford University and the SVS Advocacy Scholarship recipient for 2018, advocated strongly with lawmakers for a bill that would not limit physician’s discretion on prescribing opioids.

“It is important to allow physicians to determine the amount of opioid necessary for a patient,” she said. “Different patients have different needs and a blanket restriction to the amount of opioid that can be prescribed may be harmful to our patients. Opioids do need to be monitored, but the solution is not to tie the hands of physicians caring for patients in pain.”

In addition to leaving discretion to physicians, the new legislation includes support for non-opioid pain medications and for patient education. Surgeons are hopeful that the electronic prescription monitoring requirements will support providers without adding burdensome administrative duties.

The legislation is multi-faceted, with programs across many federal agencies. It includes treatment and recovery programs, a program for the U.S. Postal Service to screen packages (to detect fentanyl shipped from overseas), as well as programs to monitor drugs and prescriptions.

It also includes provisions for preventing addiction for “susceptible seniors,” such as expanding eligibility for medication therapy management programs under Medicare Part D and education mandates for patients and providers. That would be helpful for providers who may not be trained to recognize the signs of addiction or to ask the right questions.

“Throughout all the efforts to reduce the number of overdoses and the risk of creating dependence, the needs of the vascular patient should not be neglected,” she noted.

“We are supportive of trying to solve this problem, but the truth of the matter is that some recent proposals at both state and federal level are a bit of a nightmare to put into practice,” Dr. Tracci said.

SVS opposed a proposal that would have sharply limited prescriptions, requiring many patients – including those in terrible pain – to return to the doctor’s office to get a paper prescription to refill their pain medications.

“If you have an amputee – who went to the pharmacy at midnight and found out he couldn’t get a refill and has to find a ride to get 300 miles back to your office for a paper prescription,” she said, “you have a patient who is mad, in pain and disappointed.”

SVS remains active on the opioid issue and will continue to speak out both for those vulnerable to dependencies and for patients in pain.