AMA House of Delegates

AMA meeting: Doctors oppose mandatory drug reporting laws

Delegates worry these kinds of regulations will make patients hesitate to seek help.

By Victoria Stagg Elliott — Posted July 7, 2008

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Physicians should not be required to report to police information about patients who test positive on drug screens, according to policy adopted at the American Medical Association's June meeting.

"Physicians take an oath to first serve their patients," said AMA Board of Trustees member Steven J. Stack, MD. "We're not in the business of law enforcement. It's a violation of our confidentiality agreement."

Hawaii requires health professionals who treat drivers from a car crash to report results of any medical test that reveals intoxication or drug impairment. Tennessee considered, but did not pass, a similar bill earlier this year.

"A drug screen is an important part of a medical workup," said Stuart Gitlow, MD, MPH, a psychiatrist from New York who was speaking for the American Society of Addiction Medicine. "An obstacle has been placed in our way. The result of that type of regulation is that doctors don't perform drug screens, and the patient doesn't receive the necessary treatment or follow-up."

Physicians said such laws interfere with the patient-physician relationship.

"Mandatory reporting discourages treatment and discourages patients from coming in," said Lynn Parry, MD, a Denver neurologist who represented the Colorado Medical Society. "The law doesn't prohibit you from reporting if you think there's a danger to the public, but it shouldn't mandate it. That's a very important distinction."

Some argued, however, that required reporting of test results may be appropriate in situations such as car crashes in which drugs may have played a role.

"We need to not only look out for our patient, but the patient who could be down the hall who was also injured," said Sandeep Krishnan, a third-year medical student at the University of Missouri, Kansas City, who represented the Missouri State Medical Assn. "There's actually harm that could happen from not reporting."

Opponents noted that other routes can be used to obtain this information and legal mandates were unnecessary. A spokeswoman for the National Council of State Legislatures said there are common ways to gain access to test results if legal action results and this evidence is needed.

The resolution also called for the AMA to promote education of physicians on the importance of referring patients with positive screens for relevant care.

In related action, the AMA voiced support for "The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking" and voted to continue participating in programs to raise awareness and increase screening, diagnosis and treatment of substance use disorders.

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Meeting notes: Public health

Issue: Questions have been raised about the role high-fructose corn syrup may play in escalating obesity rates. A review suggested that increasing consumption of all forms of sugar may be involved, but that high-fructose corn syrup could not be singled out.

Proposed action: Encourage independent research into the effects of high-fructose corn syrup and recommend that people limit consumption of all caloric sweeteners. [ Adopted ]

Issue: Research indicates that recommended levels for vitamin D are too low and deficiencies in this substance may play a role in development of chronic diseases.

Proposed action: Urge the Institute of Medicine to re-examine recommended daily intake values for vitamin D. [ Adopted ]

Issue: Many hospitals require physicians to sign a written version of verbal orders within 48 hours, but physicians regard this as a waste of time and lacking evidence that it benefits patients.

Proposed action: Request from appropriate federal agencies evidence supporting this policy, and, if there is none, ask for the requirement to be rescinded. [ Adopted ]

Issue: Many blood-banking organizations regard the lifetime ban on blood donations from men who have had sex with men since 1977 as no longer necessary to keep supplies safe. It also may be discriminatory and stigmatizing.

Proposed action: Recognize that a five-year deferral is supportable by science. [ Adopted ]

Issue: Those living with chronic medical conditions are more likely to be injured or die during a disaster or in its aftermath. This may be due in part to a lack of access to usual medications.

Proposed action: Recommend patients maintain an emergency pharmaceutical reserve and always carry a detailed list of their medications. [ Adopted ]

Issue: Studies have not found "abstinence-only" education to be effective, but state and federal funding supports it.

Proposed action: Urge that mandates for "abstinence-only" instruction end and that money be redirected to comprehensive sex education. [ Referred ]

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