On December 27, 2017, Lieutenant Governor, Brian Calley, signed into law several pieces of legislation aimed at addressing the opioid epidemic. Many of the bills, which have been gradually working through the House and Senate for months, emerged out of recommendations issued by Governor Rick Snyder’s Michigan Prescription Drug and Opioid Abuse Commission in 2015. The bills passed the Michigan legislature during the week of December 11.
While MAFP has been supportive of a broader strategy to address the crisis, it was the Academy’s position that some of the bills fall short and, even worse, could have a detrimental impact on patient access to legitimate pain medication.
Of particular concern to MAFP was Senate Bill 166 (Public Act 248 of 2017) and Senate Bill 167 (Public Act 249 of 2017), which passed out of the House of Representatives on October 13 by a vote of 86-24 and 83-27, respectively. The tie-barred package would impose a mandate for all licensed prescribers in the state of Michigan to query the Michigan Automated Prescription System (MAPS) when prescribing schedules II-V controlled substances and delineates sanctions for non-compliance.
Some of the changes made to the legislation during negotiations with the physician community included an exemption from the requirement to check MAPS when prescribing less than a 3-day supply as well as modifications that would lessen the severity of some of the sanctions for non-compliance, giving more latitude back to the Board of Medicine to take disciplinary action—both were welcomed developments. Changes also included an earlier implementation date of June 2018 and a requirement to register with MAPS by that date, as well. Due to the changes made to the bills, SB 166 and 167 were sent back to the Senate for concurrence and ultimately passed by a vote of 36 to 1 and 35 to 2, respectively.
By a vote of 97-13, the House passed Senate Bill 274 (Public Act 251 of 2017), which would, among other things, prohibit prescribers from prescribing more than a 7-day supply of an opioid within a 7-day period when treating a patient for an acute condition. This legislation also raised concerns within the physician community due to its potential to curb patient access.
The House also passed:
- Senate Bill 270 (Public Act 247 of 2017) (by a vote of 102-8)—requires a bona fide prescriber-patient relationship before prescribing schedules II-V controlled substances under certain circumstances. The Department of Licensing and Regulatory Affairs will promulgate rules describing circumstances in which this relationship would not be required.
- Senate Bill 273 (Public Act 250 of 2017) (by a vote of 104-6)—would require a physician or provider who treats a patient for an opioid-related overdose to provide information to the patient on substance use disorder services.
- Senate Bill 47 (Public Act 252 of 2017) (by a vote of 104-6)—makes changes to existing statutory exemptions from checking MAPS, specifically removing the exemption when a controlled substance is dispensed directly from a physician office. It would also require that methadone clinics and physician offices that prescribe and dispense buprenorphine or methadone on premises report to MAPS.
Separately, the Michigan Senate considered and passed, by a vote of 37-1, House Bill 4408 (Public Act 246 of 2017), which would require a prescriber, upon giving a prescription of an opioid to a minor, to obtain informed consent from the minor’s parent/guardian that they were informed of the risks associated with opioids. In addition, the bill would require a prescriber, when prescribing opioids, to provide information about the risks associated with opioids, including the possibility of criminal charges for diversion abd obtain informed consent from any patient upon receipt of the information. Because of changes made to the bills in the Senate, the House also voted on the bill and it cleared the chamber by a vote of 89-21.
The Senate also passed, by a vote of 37-1, House Bills 4406 (Public Act 254 of 2017) and 4407 (Public Act 255 of 2017), which would require the Michigan Department of Education to develop a model program of instruction related to opioid risks, based on recommendations from the Michigan Prescription Drug and Opioid Abuse Commission. MAFP was one of several organizations supporting the bills. In addition, the Senate unanimously passed House Bill 4403 (Public Act 253 of 2017), also supported by MAFP, which would add “medically necessary acute medical detoxification for opioid use disorder” to the list of medical services that could be provided under the Social Welfare Act.