Authorities know the opiate crisis has come to Wyoming.
One Wyoming doctor is concerned about a potential new law that would heavily regulate the prescription of opioid painkillers in the state.
Anne MacGuire, a rheumatology doctor based in Casper and a member of the state Board of Medicine, said she was alarmed by the bill because it could lead to many patients simply going without necessary pain medication.
The Legislative Service Office does not release bill drafts without the permission of the lawmaker who is sponsoring it, but MacGuire said it would require anyone prescribing opioids in Wyoming to search each patient in a state database before writing a new prescription. If a doctor fails to do so, her license would be revoked.
The database, known as the Prescription Drug Monitoring Program, is intended to prevent patients from receiving multiple prescriptions at once, known as “doctor shopping,” and to bar other types of fraud.
MacGuire said she and other doctors already check the database regularly for all their patients. But to expect them to search the database every time they renew a prescription for even long-term patients is unrealistic, she said. On a recent weekday interview, MacGuire said she had written 15 painkiller prescriptions for patients. Because searches can take up to 20 minutes to perform, MacGuire said that she could not use it to look up every patient when she renews their supply of painkillers.
With the threat of losing her medical license if she failed to search the patient and document the results, MacGuire said she and many others would simply stop filling painkiller prescriptions in many instances.
“It’s too big a club for me to take the time to write for a prescription that is not going to save somebody’s life — it’s going to make their life better or easier but isn’t going to make a difference life or death and it puts my job at risk,” MacGuire said. “Everybody else in the state would do the exact same thing.”
Authorities know the opiate crisis has come to Wyoming.
MacGuire said the measure was being sponsored by Rep. Jim Byrd, D-Cheyenne. Byrd did not respond to an email or voicemail seeking comment. Byrd does not sit on the Legislature’s health committee and would likely need to bring the bill before the entire House for it to be considered, meaning it might bypass the type of hearings that committees hold before deciding whether to sponsor a measure.
Board of Medicine Executive Director Kevin Bohnenblust said he was not authorized to discuss the legislation.
Overdoses, including deaths, from opioids have been a growing problem across the country with abuse of pills and heroin spiking in certain regions. President Donald Trump recently declared a national public health emergency due to the opioid epidemic.
But MacGuire disputed the need for a new law in Wyoming. She said that the state did not have a problem with doctor shopping or an opioid epidemic locally.
“The regulation of narcotics is already huge in the state, and we don’t need another layer of regulation with the threat of loss of licensure,” MacGuire said.
But Aimee Lewis, chair of Wyoming Prescription Drug Abuse Stakeholders, said that’s not true. Prescription pain medication and heroin are both big problems in the state, Lewis said, though she had not reviewed the proposed legislation and could not comment on the details.
The bill is based on language from North Carolina, and Lewis said it would be useful to track the effectiveness of similar laws in states where they have been implemented.
Wyoming disliked the Environmental Protection Agency’s Clean Power Plan, a 2015 proposed regulation on utilities that aimed to cut carbon dioxide emissions by more than 30 percent.
State economists said the plan would take a painful bite out of Wyoming’s coal production. At worst, production could see a 50 percent cut as states turned away from coal-fired power, some estimated.
But the last couple years were unkind to coal, anyway. Wyoming coal production shrank by about one-quarter in a tumultuous market, while the CPP bounced through courts with years to go before its implementation. No one is sure of the plan’s fate since the change of administration in Washington has promised its repeal, and few expect coal production to come charging back with or without the federal regulation.
Either way, the EPA’s reputation in Wyoming is complicated to say the least.
The Clean Power Plan is a perfect analogy for the changes working their way through the agency now, said Doug Benevento, the new regional administrator for the EPA in the Rockies and the High Plains.
He sat down for an interview with the Casper Star-Tribune on Tuesday to talk about the agency’s direction under the new administration and what that will mean for environmental issues in the energy dependent state of Wyoming.
The central focus on climate change is being replaced at the EPA, Benevento said. It distracted the agency away from some of its core responsibilities, he said, mentioning the water crisis in Flint, Michigan, where locals are still reporting a host of serious health effects due to lead in the water.
“You look at Flint, and you say that was the failure of the agency,” he said. “I want to make [drinking water] a focus and I think that’s a focus that’s more immediate to people than implementation of the Clean Power Plan.”
The Trump-appointee has been on both sides of regulations, he said. He has held a number of public positions from the school board to the Colorado Department of Public Health and Environment. Before filling the EPA role, Benevento was the energy policy director for Xcel Energy, a utility based in Minneapolis, that like many across the country is currently transitioning away from coal-fired power.
His Wyoming visit included meetings with state regulators at the Department of Environmental Quality and the Wyoming Oil and Gas Conservation Commission. He also spoke with the governor and various industry groups including the Wyoming Mining association.
He did not meet with the environmental groups active in the Cowboy State, but said he would like to.
Wyoming has a strange relationship with the EPA, traditionally preferring to establish primacy over as many regulatory issues as possible, from air quality to ground water. The agency regulates drinking water and some industrial wells, and its rules set a baseline for environmental regulations in the state on a host of issues.
Otherwise, it’s treated as a funding arm for state programs.
About 30 percent of the state’s Department of Environmental Quality budget is paid for with federal dollars, some through the EPA. The federal agency also contributes millions in grants annually to various projects in Wyoming, such as cleaning up the residual flow of toxins carried into streams. The Oil and Gas Conservation Commission also receives EPA funds to carry out its programs.
Benevento share’s what many in Wyoming say is the EPA’s role: provide money and oversight, but step back and let states regulate themselves day to day.
He balked at the word “oversee” in regard to state oversight.
“We probably need to move away from the mindset that states need to prove they are doing their job,” he said. “We need to ask the right questions. We need to assume that Todd Parfitt (of the Wyoming DEQ) or the folks of South Dakota are concerned about their environment probably more than I am sitting in Denver.”
But the funding issue is a central one. Proposed cuts to the EPA from the Trump Administration, and more modest cuts in current budget proposals from Congress, have caused some concern in Wyoming.
A number of state programs are dictated by federal law and carried out with federal dollars. But Benevento said he did not believe the most recently proposed cuts would hinder Wyoming.
They are anticipating a tighter budget, he said.
From Denver, the EPA is looking at ways to reduce red tape and duplicative demands that can cost states unnecessary dollars or manpower.
In recent years, Wyoming and the EPA have had different takes on some key issues.
In the gas fields of Pavillion, homeowners said fracking and relating practices had polluted their water and turned to the EPA for help.
The federal agency draft report found that gas actives were likely a cause of the pollution. After Wyoming took over that investigation, the state published a finding disagreeing with the EPA’s conclusion. Pavillion remains a matter of contention in Wyoming. Finding out who was right depends on who you ask.
For some locals, Wyoming bent to pressure from industry where the federal agents were unwilling to bend. The story was further complicated by reporting from the Star-Tribune that revealed reticence from Washington to come down on fracking had pushed the issue back to the states.
So, for Benevento’s EPA, will the agency speak as an outside voice?
Yes, he said, with the caveat that based on his own experience there is no inherent conflict between states and their industries.
“In our view, there is not a contradiction between wise energy development and environmental [stewardship,]” he said.
Ultimately, Benevento said he believes that the federal agency’s primary responsibility is human health and environmental protections that are guided by science. But second to that is seeking out common sense ways to accomplish environmental goals that are feasible, he said circling back to the way the EPA had approached the carbon dioxide issue and Wyoming’s least favorite of the EPA’s rules.
“I don’t think the Clean Power Plan was sound,” he said. “There are better ways to do things.”