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<p>HARTFORD, Conn. (AP) &#8212; 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.</p><p>Connecticut and Alaska are two of the latest considering legislation this year that would create a &#8220;non-opioid directive&#8221; patients can put in their medical files, formally notifying health care professionals they do not want to be prescribed or administered opioid medications.</p><p>Legislators in Massachusetts and Pennsylvania last year voted to create similar voluntary directives.</p><p>While patients typically have the right to make decisions about the medical care they receive and whether they want certain treatments, proponents of non-opioid directives contend such a document make a patient&#8217;s wishes clear, especially in advance of medical care or if a patient becomes incapacitated. They are also seen as a way to prevent someone in addiction recovery from relapsing. The National Institute on Drug Abuse notes how exposure to drugs is one of the most common triggers for relapse.</p><p>&#8220;Whether it&#8217;s in some type of directive in a treatment plan, we have a right to choose what we want in our care,&#8221; said Kelvin Young, who is recovering from opioid and heroin addiction and is now director of Toivo, an alternative drug rehabilitation program in Hartford.</p><p>Such directives, however, are not a one-size-fits-all solution.</p><p>Seth Mnookin, an assistant professor at the Massachusetts Institute of Technology graduate program in science writing, acknowledged they&#8217;re &#8220;not the most nuanced approach to the problem.&#8221; He has written about taking opioids almost two years ago for kidney stones and a related infection, even though he previously kicked a three-year heroin addiction in 1997.</p><p>&#8220;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,&#8221; said Mnookin, who said it felt like his &#8220;gut was being hacked at with a phalanx of rusty chisels.&#8221;</p><p>During his hospital stay, Mnookin said, he repeatedly told doctors about his substance use disorder. However, he felt they weren&#8217;t listening. Ultimately, he did not receive any counseling or advice regarding the risk of a potential relapse or how to guard against one. He wound up creating his own chart to ensure he didn&#8217;t take too many pills.</p><p>&#8220;That&#8217;s not something I think everyone is going to do,&#8221; he said.</p><p>Mnookin said states should consider requiring patients with substance abuse histories to see an addiction specialist after receiving pain medication to prevent a relapse.</p><p>&#8220;In my case, I would not have written a directive,&#8221; he said. &#8220;But, the fact that this legislation is being introduced means there&#8217;s awareness of the necessity of having more conversations, having people outside of an addiction specialist being aware of people&#8217;s histories.&#8221;</p><p>Sue Kruczek, of Guilford, Connecticut, has worked to pass opioid legislation since her 20-year-old son Nick died in 2013 of a heroin overdose following an addiction to prescription drugs.</p><p>&#8220;It seems like the hospitals are unaware of the history,&#8221; she said.</p><p>In Massachusetts, a patient, or the patient&#8217;s guardian or health care agent, signs a one-page form that states: &#8220;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.&#8221; The person also agrees they understand the risks of refusing and release the health care professionals &#8220;from any responsibility for all consequences.&#8221;</p><p>The directive, which must also be signed by the health care practitioner, became available in January. The Pennsylvania directive is still being developed.</p><p>Pennsylvania state Rep. Ed Gainey, a Democrat, proposed the directive legislation. Representing a section of Allegheny County that&#8217;s seen hundreds of opioid overdose deaths over the past two years, Gainey said he sees the directive as a patients&#8217; rights issue, an opportunity to empower people who may fear relapsing into addiction, but also becoming addicted.</p><p>&#8220;My whole thing is, &#8216;how can we give patients more control over their destiny?&#8217;&#8221; he said. &#8220;A lot of people are more aware now and while they&#8217;re more aware, it&#8217;s good that we let them know they have an option to opt out and not receive prescription drugs.&#8221;</p><style>
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<div class="neCaption">In this May 27, 2016 photo, Sue Kruczek, of Guilford, Conn., holds the last photo taken in 2013 of her entire family during a news conference at the Legislative Office Building in Hartford before Gov. Dannel P. Malloy, right, signed legislation limiting opioid prescriptions. Her 20-year old son Nick died of an overdose. Several states are considering legislation to create a non-opioid directive that patients can put in their medical files, formally notifying health care professionals do not want to be prescribed or administered opioid drugs. (Brad Horrigan/The Hartford Courant via AP) </div></div><div class="metaInfo"><photo0>https://www.timesleader.com/wp-content/uploads/2017/03/web1_AP17073549392948-1.jpg</photo0><caption0>In this May 27, 2016 photo, Sue Kruczek, of Guilford, Conn., holds the last photo taken in 2013 of her entire family during a news conference at the Legislative Office Building in Hartford before Gov. Dannel P. Malloy, right, signed legislation limiting opioid prescriptions. Her 20-year old son Nick died of an overdose. Several states are considering legislation to create a non-opioid directive that patients can put in their medical files, formally notifying health care professionals do not want to be prescribed or administered opioid drugs. (Brad Horrigan/The Hartford Courant via AP) </caption0><photoCredit0></photoCredit0></div></div>
<div class="metaInfo"><bylineMeta><p>By Susan Haigh</p><p>Associated Press</p></bylineMeta></div>

No opioids, please: Clearing the way to refuse prescriptions