Dr. John Mulder, director of the Trillium Institute, appeared before a hearing in the House Subcommittee on Health, a part of the Committee on Energy and Commerce, on combating the opioid crisis.  Dr. Mulder, an expert on hospice and palliative care for over 30 years, was invited to give testimony at the hearing by the National Association for Home Care & Hospice (NAHC).  He urged the House of Representatives to pass H.R. 5041, the Safe Disposal of Unused Medication Act that would authorize employees of a hospice program to handle controlled substances in the residence of a deceased hospice patient in order to assist in the disposal of the drugs.

Dr. Mulder testified that the opioids often prescribed to treat pain in terminal patients sometimes go unused by the patient.  Under almost all current law in the United States, hospice staff may not handle or destroy dangerous medications that pose a risk for diversion and misuse.

H.R. 5041, sponsored by Rep. Tim Walberg (R-MI-7), will allow qualified hospices to authorize licensed employees to handle controlled substances in the residence of deceased hospice patients in order to assist in proper disposal of those medications.

Dr. Mulder also provided testimony on the impact shortages of opioids and other pain medications, because of the temporary shutdown of production in Puerto Rico due to Hurricane Maria and the DEA’s reduction in production quotas, would have on the ability of hospices and palliative care physicians to address intractable and debilitating pain in their patients.    

Dr. Mulder encouraged the DEA and the Food and Drug Administration and other appropriate federal agencies to ensure that a process is in place to track supply needs, anticipate shortages and quickly address them in a way that does not threaten continuity of care or increase the cost of effective care delivery. 

Of great concern to Dr. Mulder are provisions in legislation that is being developed requiring a prescriber to have a “bona fide” relationship with the patient and more specifically, how they define such a relationship.  The concern stems from potential delays in delivering much needed pain relieving medications in a timely manner.

In a similar vein, many hospices are finding growing numbers of community physicians are hesitant to prescribe pain medications for patients with advanced or terminal illness because of the intense scrutiny that prescribing practices are receiving throughout the nation.  It is of note that it is not patients at the end of life, nor hospice physician prescribers, who have influenced the current opioid misuse and addiction issues.