With addiction to prescription painkillers on the rise in Hawaii, state lawmakers prioritized legislation this session aimed at cutting down on abuse and making sure that health care providers counsel patients on the risks of opioid medications.

But as this legislative session nears an end, lawmakers are still trying to come to an agreement on a bill, and the current proposal has stirred opposition from doctors, drug policy advocates and community groups on the front lines of dealing with drug abuse.

Senate Bill 505 would require prescribers to counsel patients about the risks of becoming addicted to and overdosing on opioids, the risks of taking the pills if pregnant, and alternative treatment options for pain, in addition to other requirements, for initial prescriptions. Patients would also have to consent to periodic urine drug screenings, according to the latest version of the bill.

A treatment agreement including these risks would also have to be provided in writing and signed by the prescriber and patient.

The measure also limits initial prescriptions of both opioids and benzodiazepines, except under certain circumstances, to seven days. Commonly prescribed opioids include such painkillers as hydrocodone and oxycodone. Benzodiazepines include tranquilizers such as Valium and Xanax.

Doctors say both can be addictive and, when used in combination, can lead to lethal overdoses.

The seven-day limit for initial prescriptions would be waived under a number of circumstances, such as when a patient has undergone an operation or when someone is in palliative or hospice care.

A growing crisis

Hawaii has seen a growing rate of drug overdose deaths in recent years. In 2008, deaths from drug overdoses surpassed motor vehicle fatalities for the first time, according to data from the state Department of Health.

Overdoses are being fueled, at least in part, by opioid abuse.

Between 2010 and 2014, opioid pain relievers accounted for 35 percent of the drug overdose deaths, a figure that may actually be underestimated due to data gaps, according to the Health Department. In recent years, more than 150 people have died annually in Hawaii from opioid overdoses.

Sen. Josh Green (D, Naalehu-Kailua-Kona), who is also an emergency room doctor on Hawaii island, has supported legislation targeting opioid abuse for several years and is a co-sponsor of Senate Bill 505.

He said he’s seen a rise in addiction to pain pills in recent years, as well as patients turning to street drugs, including heroin and methamphetamine, if they can’t get prescription drugs.

He said that the informed consent portion of SB 505 was particularly important and that the medical community needed to be more aware that initial prescriptions for painkillers can lead to more significant problems.

“We as a medical community need to own this problem, and if it means a little extra work or some extra follow-up visits, I think it is probably worth the sacrifice of time to make sure that people aren’t getting addicted or getting too many pills,” he said.

Americans consume about 80 percent of the global opioid supply, according to the American Society of Interventional Pain Physicians. And a recent federal study found that more than 1 in 3 American adults were prescribed painkillers in 2015.

“America really has lost its way on addiction of these medications,” said Green. “That is why we are having legislation. It is not usual to have legislation on health issues like this, but there has been this big surge of that across the country because of the number of addicts. So now we are forced to actually regulate the medical community.”

“It is tough as a doctor for me to be a part of that, but I saw it from the policy perspective,” Green continued. “It’s just far too many people were becoming addicted.”

Discord over solution

However, there’s still no agreement among the medical community, drug policy experts and legislators about how to address the rising problem.

Senate Bill 505 has received pushback from groups such as The Drug Policy Forum of Hawai‘i and the CHOW Project (the Community Health Outreach Work to Prevent AIDS Project), which assists people with drug problems, as well as groups representing local doctors.

The Drug Policy Forum of Hawai‘i has argued that the seven-day limit on prescriptions is arbitrary and could run counter to patient needs, especially given doctor shortages in rural areas. The policy group has also said that the measure is too focused on the supply side of the problem, as opposed to suffering patients.

Our “concern remains that this arbitrary limit could push patients in need of pain relief towards more dangerous drugs,” wrote Carl Bergquist, the nonprofit’s executive director, in testimony on the bill.

Groups such as the Hawaii Medical Association, the American College of Emergency Physicians and the American Congress of Obstetricians and Gynecologists in Hawaii have raised concerns that physicians could be charged with felonies for noncompliance with the measure, or if they make a mistake. They’ve asked that the measure be amended to ensure this isn’t the case. ACOG also raised concerns that the bill interferes with the physician-patient relationship and patient confidentiality.

The bill was heard in conference committee on Friday, where select members of the House and Senate hammer out final differences on bills.

Sen. Rosalyn Baker (D, West Maui-South Maui), chairwoman of the Commerce, Consumer Protection and Health Committee, said that conferees were “making some progress” on the measure and planned to clean up some of the bill’s language and review new Health Department recommendations. The conference committee is scheduled to take up the measure again on Monday.