I recently received an email from a friend who is part of the chronic pain community. In one of her Facebook groups, someone had posted the text of a bill that had been introduced in the U.S. House of Representatives. She sent it to me and asked how she should respond. When I looked, I knew immediately that it was a ridiculous bill and that it wasn’t going anywhere, but my friend’s comrades were, to use a phrase, freaking out.
The Facebook post was urging members to contact their Representatives and Senators to block a bill that would require additional licensing requirements for prescribers of opioids in an attempt to address the opioid addiction crisis. Among other things, one provision would outlaw the prescription of any opioid that exceeded maximum daily strength recommendations set by the Centers for Disease Control and Prevention (CDC) in 2016. Another provision would require any practitioner seeking a federal license to prescribe controlled substances to be trained to follow more CDC guidelines that require that no prescription for pain medication exceed a 72-hour supply of pain medication in a one-year period.
Having not spent the decades I have reading, analyzing, and sometimes writing federal policy (writing was only at the agency level, not legislative), looking for issue trends and figuring out what was moving and what wasn’t, I understood why pain patients would find this so alarming.
So. Time out. Again.
First, let’s take a look at the provisions.
The first one is the scarier of the two. But the vetting process –evaluating the pros and cons, trying to assess whether the positive impact on one population outweighs the negative impact on another population, would have knocked out this provision. Pain management is tricky partly because it is subjective and fluid. Even patients with acute pain from, say, surgery or after a bad car accident, may need temporary doses higher than CDC guidelines to assist in their recovery.
The second provision is a little easier to take the sting out of: as it is written, the provision requires that prescribing practitioners take training, not follow it. Legislative language is its own special form of legalese. To understand what may or may not become law, you have to evaluate the exact phraseology even more than the overall intent of the bill.
Second, let’s look at the metadata (for lack of a better term) around the bill. It was introduced in July, went to committee, and hasn’t moved since. If it were a priority, something would have happened by now. Additionally, there are only two co-sponsors* listed, a freshman Congresswoman from Connecticut, and a non-voting Representative from Guam. This indicates that support for the bill is not strong. Bills without strong support don’t pass.
And finally, let’s take a look at the general workings of Congress. A Congressional session is only two years. Anything that doesn’t pass by the end of the session has to start all over again in the next Congress, which may have a more or less favorable make up than the current Congress. This session ends on December 31st. Considering the election, the pandemic, and the economic crisis, I suspect the only bills that will pass for the rest of the session will be related to keeping the country functional. If all of that wasn’t enough, consider the forces aligned against a bill like this. It’s not just the freaked-out pain patients, but the providers and prescribers who care for them, and the ever-present and very powerful PhRMA, which lobbies on behalf of the drug manufacturers.
Because it can greatly affect our lives in both directions, many chronic and autoimmune patients are in groups that monitor both state and federal legislation so we can act (contact our legislators) if we feel that we need to support or oppose a bill. This is our right and our privilege as citizens. But understand that thousands of bills are introduced every session, and very few actually pass. With our limited energy, we should only spend it on the things that are likely to become reality.
I hope that with this post, we have given you some tools to evaluate both the exciting and the scarier ones, and with them a little more peace of mind.
Time in. Again.
*Co-sponsorship of legislation is a way to show support for a bill or resolution before it comes up for a vote. The more co-sponsors, the more likely it is to pass.