A bill to decriminalize fentanyl test strips moved through the Mississippi legislature without opposition and was signed into law this year, but that doesn’t mean it was an easy task to get it passed.
It took a two-year effort by AMA member and Oxford, Mississippi, psychiatrist Katherine Pannel, DO, which included a failed first effort, authoring a supportive policy resolution in the Mississippi State Medical Association (MSMA) House of Delegates, speaking at committee hearings, nonstop education and a strongly worded op-ed that she described as a “hail Mary” pass to get the bill—which the AMA strongly supported—into the legislature’s end zone.
After passing the state House of Representatives, the bill was “double referred” in the Senate, meaning it was assigned to two separate committees—which is often seen as a sign that the chamber’s leadership is not supportive of the measure.
“Legislatively, double referral is like the kiss of death,” said Dr. Pannel. “It’s a signal to the lawmakers that this is not a popular bill that the leaders in the Senate want to pass.”
Dr. Pannel wrote an op-ed that noted the futility of current strategies to curb overdose deaths and stressed that everyone with a substance-use disorder (SUD) is capable of recovery—and using fentanyl test strips can keep people alive so they can make to it to recovery.
“Passing this legislation should be a no-brainer but—up to this point—it has not been,” Dr. Pannel wrote.
“It is due to the misconception that somehow these strips will enable those with substance-use disorders to continue to use,” she added. “This is such a shortsighted thought process. And quite frankly, saying you do not want to equip substance users with these strips means you would rather them die.”
Dr. Pannel concluded the column by noting that there was zero evidence that fentanyl test strips enable illicit drug use, but decriminalization in other states has proven that their use saves lives.
“The Mississippi State Medical Association was so integral to this effort because they took my op-ed and pushed it out to every outlet they could,” said Dr. Pannel, who serves as an MSMA trustee as well as a trustee for the Mississippi Osteopathic Medical Association and chairs the Mississippi State Psychiatric Association’s Council on Legislation.
She also appeared on talk radio to push the bill.
“Our association applauds the passion and determination of Dr. Pannel to move this issue from our House of Delegates through the Mississippi Capitol and into state law,” MSMA President John Cross, MD, said. “Availability of these testing strips will allow our patients to have a chance for recovery and will save lives.”
Visit AMA Advocacy in Action to find out what’s at stake in ending the overdose epidemic and other advocacy priorities the AMA is working on.
Why coalitions matter
She credits a coalition featuring the MSMA, osteopaths, psychiatrists, pediatricians and family medicine physicians for getting the bill passed.
“We’re stronger in numbers,” Dr. Pannel said. “We’re fighting the same battles, so we need to come together and fight together. And that’s exactly what happened and why we were successful.”
She also noted that, when lobbying legislators, physicians need to come prepared with data and stories to tell about how existing laws affect patients.
Drug-related overdose deaths exceeded the 100,000 mark in the U.S. for the first time in 2021. Drug overdoses and deaths are being fueled by illicitly manufactured fentanyl, methamphetamine and cocaine, and these deaths are amplified by barriers to evidence-based care, ongoing inequities, and underlying social needs.
“The staff of the Mississippi State Medical Association, alongside our member physicians, have worked diligently with lawmakers to educate them on the importance of decriminalizing fentanyl test strips,” said Claude Brunson, MD, the MSMA’s executive director.
“The partnerships with organizations throughout the state and coordination of efforts has strengthened each of our voices in the effort to save the lives of Mississippians,” Dr. Brunson added. “Dr. Pannel’s passion, determination and leadership on this issue was the catalyst that got this bill through the legislature and on the governor’s desk for his signature.”
In Mississippi, there were 586 fatal drug overdoses in 2020 and 21.1 overdose deaths per 100,000 residents, according to data from the Centers for Disease Control and Prevention.
When it came to patient stories, Dr. Pannel has a strong—and very personal—story to tell.
“The story I’ve used throughout this battle is my father’s and it’s part of the reason I do this,” Dr. Pannel said.
“He had a severe substance-use disorder and went through treatment multiple times and, eventually, one of those times clicked and it worked, and he has been in recovery for over 20 years,” she added. “It would’ve been so easy to just dismiss him early on and just see him as a lost cause.”
The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA’s End the Epidemic website.
Clearing up misconceptions
While the decriminalization bill was seen as a harm-reduction measure, the legislation itself never used the term.
This was not an intentional strategy to avoid the term, Dr. Pannel said. It was viewed that the best path to success was not to create a new bill, but to rewrite the legislation that classified fentanyl test strips as illegal drug paraphernalia so that it stated the opposite.
In fact, she said, using the term helped get the legislation passed.
“There is so much stigma surrounding fentanyl test strips, that I think using the term ‘harm reduction’ in conversations really lessened that stigma,” Dr. Pannel.
As an osteopathic psychiatrist, Dr. Pannel has had to work against misconceptions regarding her credentials.
“I feel like we’re always having to clarify a little,” she said. “I’m a psychiatrist. I went to medical school, but sometimes I get confused as being a psychologist.”
But, after 10 years in practice, that confusion occurs much less frequently than in the past.
“I never felt discriminated against, but I do feel like there were a lot a lot of questions and I was happy to clear up those misconceptions,” Dr. Pannel said.
She is far from the only DO making their presence felt in this area. Find out how Steven Stanos, DO, and his team have developed a rehabilitation-based program within their established traditional pain clinic that focuses on a three-pronged approach that targets biological, psychological and social factors that contribute to chronic pain.
Also, learn how Steven Aks, DO, and Jason Hoppe, DO, are reaching past their traditional roles of emergency care to establish warm-handoff programs for patients with an opioid-use disorder.
