These States Don’t Want You to “Just Say No” All the Time

Last updated on November 4th, 2019

Picture this: You’re in recovery from an opioid addiction. You’ve been sober for a year. You’re on your way to work, and another driver runs a red light. The next thing you know, you wake up in the ER. The accident caused some severe injuries. While you were unconscious, the doctor treated you with IV Demerol. And your chart says to give you a dose of the opiate painkiller every four hours.

You know you should tell them not to give you any more Demerol – it’s too tempting. But you’re already feeling the effects and it’s so hard to say no. After all that work to kick the habit, you feel like you’re teetering on the verge of a relapse.
If only the doctor had known the risk he was taking with your sobriety when he wrote that order.

Several states are taking action to prevent this type of scenario.

Saying No…in Advance

Massachusetts and Pennsylvania both passed legislation to create something called “non-opioid directives.” Patients can complete these directives and add them to their permanent medical files, notifying healthcare professionals ahead of time that they don’t want to be treated with opioid medications. Connecticut and Alaska are currently considering legislation to create similar directives.

These unique advanced directives provide an out for patients who are concerned about the addictive nature of painkillers. For example, the Massachusetts one-page document simply states “I am refusing at my own insistence the offer or administration of any opioid medications including in an emergency situation where I am unable to speak for myself.” The patient agrees that they understand the risks and release health care professionals “from any responsibility for all consequences.” Directives must also be signed by the patient’s healthcare practitioner.

Supporters of the legislation note these documents “make a patient’s wishes clear, especially in advance of medical care, or if a patient becomes incapacitated.” They are seen as a way to prevent relapse or original onset of substance abuse.

Concerns about these potent painkillers are certainly justified. The National Institute on Drug Abuse notes that exposure to drugs is one of the most common triggers for relapse, while the Surgeon General reports that 78 Americans die every day from an opioid overdose. Each year, overdoses from illicit drugs and prescription painkillers (often a gateway to heroin), claim a total of 45,000 lives in the US.

A Preemptive Step to Protect Patients

While these directives aren’t the solution for everyone, supporters see them as a step in the right direction. They raise awareness and provide an additional line of defense for those who need it.

Pennsylvania state Rep. Ed Gainey, who proposed the directive legislation, said he sees the directive as “an opportunity to empower people who may fear relapsing into substance abuse, but also becoming addicted. My whole thing is, ‘how can we give patients more control over their destiny?’ A lot of people are more aware now and while they’re more aware, it’s good that we let them know they have an option to opt out and not receive prescription drugs.”

Additional Reading:   Here’s How Our Nation is Fighting the Opioid Crisis

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