Some patients strive to avoid opioids


HARTFORD, Conn. — The ease of relapsing into opioid addiction has led a growing number of states to help residents make it clear to medical professionals they do not want to be prescribed the powerful painkillers.

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Connecticut and Alaska are two of the latest considering legislation this year that would create a “non-opioid directive” patients can put in their medical files, formally notifying health-care professionals they do not want to be prescribed or administered opioid medications.

Legislators in Massachusetts and Pennsylvania last year voted to create similar voluntary directives.

While patients typically have the right to make decisions about the medical care they receive, proponents of non-opioid directives contend such

a document make a

patient’s wishes clear, especially in advance of medical care or if a

patient becomes incapacitated. They also are seen as a way to prevent someone in addiction recovery from relapsing.

Such directives, however, are not a one-size-fits-all solution.

Seth Mnookin, an assistant professor at the Massachusetts Institute of Technology graduate program, acknowledged they’re “not the most nuanced approach to the problem.” He has written about taking opioids almost two years ago for kidney stones and a

related infection, even though he kicked a three-year heroin addiction in 1997.

“There was no question that I needed powerful pain medication. Having a no-opioids directive in that case probably would have created a whole bunch of problems,” said Mnookin.

During his hospital stay, Mnookin said, he repeatedly told doctors about his substance-use disorder. However, he felt they weren’t listening. He wound up

creating his own chart to ensure he didn’t take too many pills.

Specialists: Mnookin said states should consider requiring patients with substance-abuse histories to see an addiction specialist after receiving pain medication to prevent a relapse.

In Massachusetts, a patient, or the patient’s guardian or health-care agent, signs a one-page form. The directive, which must also be signed by the health-care practitioner, became available in January. The Pennsylvania directive is still being drafted.

Pennsylvania state Rep. Ed Gainey, a Democrat, proposed the directive legislation. Representing a section of Allegheny County that’s seen hundreds of opioid overdose deaths in recent years, Gainey said he sees the directive as a patients’ rights issue, a chance to empower people who might fear relapsing but also becoming addicted.

“A lot of people are more aware now,” he said. “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.”