Nevada medical board to review rules for new opioid law

The Nevada Medical Board of Examiners is delaying implementation of a new opioid prescription law after dozens of doctors complained that the change is burdensome and enforcement is confusing.

Assembly Bill 474, which went into effect Jan. 1, requires Nevada licensing boards to create regulations that outline disciplinary actions to be taken against doctors who prescribe opioids in violation of the bill, which requires physicians to perform a risk assessment on patients before writing opioid prescriptions, limit initial prescriptions of the drugs to two weeks and get the patient’s consent to random drug testing if the prescription is extended to a month.

Doctors have complained that the risk assessment takes too long and that patients are deterred from seeking help by the threat of random drug testing.

The Board of Medical Examiner’s decision last week to postpone implementing new regulations resulted from the complaints of about 40 physicians, lawyers and others who argued during a Jan. 3 meeting that the draft disciplinary rules make unreasonable paperwork demands and do not specify what types of conduct could lead to penalties or revocation of medical licenses.

“We agreed based on comments at the workshop that we should pull back our efforts to implement the draft regulations” and focus instead on developing regulations that would be fair and amenable to licensees, board Executive Director Ed Cousineau said on Jan. 12.

The board said in a statement it will create an “AB474 Working Group” to study the law, explore how it affects patients and medical providers and collaborate to develop “workable solutions” to the law’s requirements.

Cousineau said the board has not decided who will be in the working group and has no timeline for when the group will meet or when regulations will be submitted for review, but that it likely will be a six-month process. The board’s main priority, he said, is getting the appropriate parties involved in drafting the new regulations.

“There’s always someone who’s not going to get what they want,” Cousineau said.

The board has been drafting and revising the regulations contested at the Jan. 3 workshop since AB474 went into effect for administrative purposes in June.

“It wasn’t like we were sitting on it,” Cousineau said.

The board submitted the draft language at its quarterly meeting in September, received revisions from the Legislative Council Bureau in November and, because it had to wait 30 days to hold a public meeting, opted to conduct the workshop after the holidays, Cousineau said. Once assembled by the board, the working group must propose new regulations to the board for its blessing and wait for the legislative committee’s approval to put them into law.

Gov. Brian Sandoval mentioned the bill’s turbulent enrollment during a National Governors Association panel discussion last week.

“I sponsored legislation in the past two Legislatures to combat the opioid epidemic in Nevada. We lose a Nevadan every day because of this,” Sandoval said during the panel.

Sandoval said he understands physicians’ frustration with the law, but ultimately, doctors share the same goals as the legislators who wrote and passed AB 474: to curb the over-prescribing of opioids in Nevada.

”I still think that the legislation is incredibly important in terms of saving lives, and we’ll continue to work with the medical community to get them comfortable with this,” Sandoval said. “But this is the law, and it’s not going to change, and we’re going to ensure that there’s compliance with it.”

“It is going to take some time, but I think over time everyone is going to see it’s in the best interest of the patient.”