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ROBERT L. EHRLICH, JR., Governor H.B. 1287
Implementation of the program is contingent on the Advisory Board's ability to obtain
federal, private, or State funds. Implementation, however, is not contingent on the
Board receiving full or even a majority of the necessary funding. If federal or private
funds do not cover the entire cost of the program, DHMH may be required to fund the
remaining costs. Assuming federal funding is obtained, DHMH federal and general
fund expenditures could increase by $1 million in fiscal year 2007, including a
one-time cost of $500,000 to design and implement the database. The bill specifically
prohibits DHMH from seeking funds through fees from providers.
Aside from the serious fiscal implications of House Bill 1287, there are several policy
concerns with this bill. First, and most alarming, is the potential encroachment on
adequate pain management. While it is important to decrease the number of
Maryland adults and adolescents who are engaging in prescription drug abuse and
diversion, it is essential to ensure that legitimate pain management would not be
hampered for individuals who are suffering from chronic and debilitating diseases.
House Bill 1287 could have a chilling effect on providers prescribing pain
management. Prescribers are already fearful of inappropriate or unfounded scrutiny
of their prescribing practices. The provisions of this bill may exacerbate untreated or
inadequately treated pain management. Unfortunately, even after numerous
amendments, this bill focuses on law enforcement, not treatment.
Second, House Bill 1287 does not adequately address patient confidentiality.
Although the Legislature removed the prescriber's diagnosis code from the database,
many prescription medications are commonly linked to certain ailments.
Unfortunately, there are stigmas associated with certain diseases. In addition, a
patient's medical condition will be available to a multidisciplinary consultation team,
established in this bill. This bill opens the doors to non-medical individuals accessing
confidential physician-patient information since it does not specifically state who is
an authorized recipient.
Third, this legislation is problematic because it can be interpreted as providing the
federal Drug Enforcement Agency (DEA) and others with unfettered access to the
prescription drug monitoring database. Accordingly, an organization like the DEA
could search the database for the sole purpose of finding offenders to prosecute.
Fourth, House Bill 1287 emphasizes law enforcement over treatment. It is
questionable whether prescription drug data alone can be used to identify problematic
prescribing patterns especially since the data will not be supplemented by additional
information such as medical records. I do not advocate adding medical records to the
database but believe that the prescription drug data could be misinterpreted without
the proper context.
Finally, House Bill 1287 creates an Advisory Board after legislation has been
introduced. The Advisory Group does not have the ability to truly advise DHMH on
how to implement a successful prescription drug monitoring program because the law
has already been written. Legislation needs to be drafted after such a group has been
consulted.
Given all of these serious questions surrounding House Bill 1287, I have asked the
Department of Health and Mental Hygiene, in consultation with the Maryland
Health Care Commission, to form an advisory group of all the relevant stakeholders,
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