The U.S. District Court of Maine ruled last week in support of a person's right to mediation-assisted treatment (MAT) while incarcerated in Smith v. Aroostook County (PDF). This is the latest important victory in recent months after Pesce v. Coppinger. The case was spearheaded by the ACLU of Maine and included support from the Maine Association of Psychiatric Physicians, Maine Medical Association and Northern New England Society Of Addiction Medicine.

In reaching her decision, Judge Nancy Torresen noted that "the withdrawal protocol is not a treatment for opioid use disorder and that "with the help of her medication, Ms. Smith has been in active recovery for her opioid use disorder for approximately ten years. During that time, Smith has regained custody of her four children, secured stable housing for her family and obtained employment."

Judge Torresen emphasized that "based on the evidence offered by the Plaintiff's experts, the available scientific evidence and Ms. Smith's medical history, I find that forcing Ms. Smith to withdraw from her buprenorphine would cause her to suffer painful physical consequences and would increase her risk of relapse, overdose and death."

AMA model legislation includes provisions that would require state departments of corrections and all other state entities responsible for the care of persons detained or incarcerated in jails or prisons to ensure all persons under their care be assessed for substance use disorders, and also require them to make MAT available without limitation or restriction on the type of medication or other treatment prescribed by the person's physician.

For more information, e-mail the AMA's Daniel Blaney-Koen.

Idaho's Governor Brad Little recently signed into law H.B. 182 – the most liberal expansion of pharmacist scope of practice in the country. The new law allows pharmacists to independently diagnose and prescribe drugs to patients for conditions that in the pharmacist's judgment:

  • Do not require a new diagnosis
  • Are minor and generally self-limiting
  • Have a Clinical Laboratory Improvement Amendments-waived test used to guide diagnosis or clinical decision-making
  • Threatens the health or safety of the patient if a prescription was not immediately dispensed

As enacted, the bill removes language that required the Board of Pharmacy (BOP) to authorize conditions for which pharmacists may prescribe. While far from perfect, this previous legislation, which was enacted in 2017 despite strong opposition from the AMA and Idaho Medical Association, limited pharmacist prescriptive authority to specific conditions authorized by the BOP and approved by the legislature. This regulatory process at least afforded the physician community the opportunity to comment on conditions prior to approval by the BOP and resulted in some important patient safety provisions.

H.B. 182 moved swiftly through the statehouse, passing the House and Senate unanimously. In a letter to Governor Little (PDF), AMA Executive Vice President and CEO James L. Madara, MD, expressed the AMA's strong opposition to the bill and deep concerns that this legislation "grants pharmacists wide latitude to prescribe medications to patients, young and old, regardless of the severity or complexity of the patient's condition and including such illnesses as cancer, bipolar disorder, glaucoma, hypertension and diabetes." Dr. Madara further emphasize that "the AMA is deeply concerned with how this legislation is drafted and the assumption that it will be applied conservatively. Make no mistake, this legislation allows pharmacists to provide medical care for which they are not trained, without access to patients' full medical records, in a setting that is not conducive to performing a full medical examination or protecting patients' privacy. This bill is illogical and impractical in its application and raises serious patient safety concerns."

The AMA and the Medical Society of New Jersey (MSNJ) applauded this week's announcement by New Jersey Governor Phil Murphy and state Human Services Commissioner Carole Johnson for helping end needless administrative barriers to evidence-based treatment for patients with an opioid use disorder. Effectively immediately, New Jersey Medicaid will no longer require prior authorization for MAT.

"The AMA strongly urges all states that have not taken this step to do so immediately," said Patrice A. Harris, MD, MA, president-elect of the AMA and chair of the AMA Opioid Task Force. "Removing prior authorization for MAT should be occurring in every state Medicaid agency—and in the commercial and self-insured markets. As we know from our patients, delayed treatment can have deadly consequences."

"The Medical Society of New Jersey fully supports the announcement and the increased access to treatment for our patients," said John Poole, MD, MSNJ president.

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