States Consider Allowing Patients To Refuse Opioid Prescriptions

By Paul Gaita 03/22/17

Connecticut and Alaska are considering legislation that may help patients in recovery avoid opioids and relapse risks. 

Patient refusing medical prescription.

Four states are taking strides to help reduce the devastating impact of opioid addiction, by considering legislation that would let patients decide if they want to receive such painkillers as part of their treatment.

Connecticut and Alaska recently joined Pennsylvania in voting to draft voluntary "non-opioid" directives, which would make clear to medical professionals that a patient is refusing any opioid medications, especially in advance of medical care or if the patient becomes incapacitated due to illness or injury. Proponents have also noted that the directives can help a patient who may be in recovery from receiving such drugs and risking relapse. 

Non-opioid directives became available to Massachusetts patients in January. There, a patient, patient's guardian or health care agent, signs a form that states their refusal, at their own insistence, the "offer or administration of any opioid medications including in an emergency situation where I am unable to speak for myself."

The directive also clarifies that the patient or their representative is clear about the risks of turning down such medication, and releases prescribing health care professionals "from any responsibility for all consequences."

Recovery specialists and patients alike acknowledge that such directives cannot address every medical situation. Case in point: Seth Mnookin, an assistant professor at the Massachusetts Institute of Technology (MIT) and a recovering heroin user. When Mnookin was hospitalized for kidney stones and a related infection nearly two years ago, he recalled telling doctors that he had a substance abuse issue, but received no advice on how to contend with the pain beyond opioids or how to avoid relapse.

He ultimately drafted an independent chart to keep track of how much medication he was taking. "That's not something I think everyone is going to do," he noted.

"There was no question that I needed powerful pain medication. Having a no-opioids directive in that case probably would have created a whole bunch of problems," said Mnookin. "But the fact that this legislation is being introduced means there's awareness of the necessity of having more conversations, having people outside of an addiction specialist being aware of people's histories."

Pennsylvania State Representative Ed Gainey views the directives as a chance for patients to determine what sort of treatment they will receive if they are hospitalized. Gainey, who proposed his state's directive legislation, says that "[giving] patients more control over their destiny" is his key. "A lot of people are more aware now and while they're more aware, it's good that we let them know they have an option to opt out and not receive prescription drugs." 

A new study, published in the CDC's Morbidity and Mortality Weekly Report, underscored the importance of limiting prescriptions for opioid medication. Data compiled for the report showed that an initial prescription that provided opioid medication for three or fewer days reduced the likelihood of long-term opioid use. The chances of developing a long-term dependency on opioids increased with each additional day of medication supplied, according to the report.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.