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‘Last minute’ process resulted in ‘flawed’ fentanyl testing law

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(The Center Square) — A deluge of work that packed dozens of bills in the Pennsylvania General Assembly into a few days meant that legislators voted based on limited information.

The result, some of them said, is that bad bills are now the law of the land.

One example is Senate Bill 863 — Act 43 of 2023 — that gained unanimous approval in the Senate and only saw 37 votes against it in the House. The law requires hospitals to test for fentanyl and xylazine in emergency rooms when completing a urine drug screening.

If a patient tests positive for either drug, health care providers will report it to the Department of Health. It also requires the Department of Drug and Alcohol Programs to create a public awareness campaign about the dangers of xylazine, an animal tranquilizer also known as “tranq,'” and create informational materials warning the public.

Sen. Doug Mastriano, R-Chambersburg, who introduced the legislation, argued that hospitals need to expand testing.

“We have an opportunity to enact a law to save lives,” Mastriano said in a press release. “Testing for fentanyl can mean the difference between life and death for someone who has unknowingly been poisoned with it … these tests can provide health care professionals with the information they need to treat people poisoned with fentanyl and xylazine.”

In his comments on the Senate floor on Dec. 13, Mastriano argued that the state needed to require testing to combat the overdose epidemic, which has caused the deaths of more than 5,000 Pennsylvanians annually in recent years.

“Pennsylvania suffers greatly at the hands of that awful drug,” he said.

Other legislators, however, warned of the flawed process to pass the bill — and said the law will do little to help Pennsylvanians who are addicted.

“It’s one of those bills that showed up at the last minute with no discussion, no review,” said Rep. Tim Twardzik, R-Frackville, who voted against the bill in committee, along with Reps. Dawn Keefer, R-Dillsburg, and Tarik Khan, D-Philadelphia.

“The process was bad and the bill is worse,” Twardzik said. “It (got out of the Senate) under the wire … the disappointment was we weren’t doing any amendments during our committee hearing. Bills should really be fixed in the committee; they shouldn’t wait to go to the floor.”

Twardzik opposed the bill after hearing “strong objections” from health care workers at the Lehigh Valley Health Network.

“It’s not good for legislators to mandate the aspects that medical professionals work under,” he said. “The legislation will increase our costs and add chaos because the hospitals will scramble to try to do these new tests.”

The rushed process, Twardzik argued, is why “bad legislation” gets through.

“We pass 15 bills for 98% of the year and we’re looking at these giant stacks of paper coming in and trying to do 80 bills a day 3 days in a row — that’s really a sad way to do business,” he said.

Keefer opposed the bill due to a lack of input from stakeholders, vague language in the bill, and the focus on stats over treatment.

“As written, the bill ignores the patients in lieu of data collection and reporting,” she said. “There is nothing regarding notification nor standard of care for the patient, just data collection and submission.”

She also questioned the reliability of the toxicology tests and called a state mandate “premature.”

“At a time when our hospitals are overwhelmed, our healthcare workforce remains anemic, and opioids are consuming a growing number in our communities, the Department of Health doesn’t need to be compounding the struggles with a data collection mandate,” Keefer said. “Our first task at hand must be the patients and educating providers at every level of the drug abuse care continuum.”

Khan, who has been a nurse practitioner since 2011, rooted his opposition to the law in his professional experience.

“We need to focus our resources on interventions that address the issue we know already exists, including improving access to recovery, treatment, and education,” Khan said. “Testing is helpful if it will inform and change how you clinically treat patients … I have concerns about mandates for a test that doesn’t change clinical treatment.”

It’s already well-known in health care that fentanyl has tainted the drug supply, he noted, and worried that the mandatory testing would create more barriers to drug users getting help.

“My concern is that patients will be subjected to worse penalties for testing positive for these additional substances with very little in the way of positive benefit,” Khan said. “There is a long history of stigmatization and discrimination towards individuals screening positive for substances by healthcare professionals. This type of screening would not have any benefit in the form of increased quality or availability of care.”

Though legislators on both sides of the bill emphasized their concern for reducing overdose deaths in the commonwealth, how to do so divided them.

“This (law) is not gonna help anybody who’s suffering from the ill effects of the drugs,” Twardzik said.

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