Chairperson Barto, Vice-Chair Pace, members of the Committee:

I am a practicing general surgeon in Phoenix for over 40 years, and a senior fellow in health policy at the Cato Institute in Washington, DC.

If the past 2 years dealing with the COVID-19 pandemic have taught us anything, it’s that medical science is a work in progress. Assumptions and understandings are constantly being revised. Medical scientists often openly and honestly disagree over how to interpret data and what to do about it. And individual patients respond in different, individualized ways to medical and public health interventions. Medical science is nuanced. There is no “one-size-fits-all.” And “one-size-fits-all” solutions always have unintended and often harmful consequences.

That’s why it has never been a good idea to cast in stone—by placing in statute—the proper dosage and treatment of any medical condition. Medical opinions vary and change, and each patient’s clinical situation has its own uniqueness. Thankfully, we haven’t legislatively cast in stone the dosage and amount of medication for the treatment of high blood pressure. Or diabetes. And we should not have done so for the treatment of pain. Because the treatment of pain is concretized in statute, health care practitioners are handcuffed as new scientific information and new treatment recommendations arise.

In 2019 the CDC issued an advisory stating their 2016 Guideline for Prescribing Opioids was being misinterpreted and misapplied. The CDC is in the process of revising their guidelines and may publish them later this year. Last summer the FDA conducted a workshop “with the goals of providing an understanding of the science and data underlying existing MME calculations for opioid analgesics, discussing the gaps in these data, and discussing future directions to refine and improve the scientific basis of MME applications.” They held this workshop because so many pharmacologists and biochemists have criticized the morphine milligram equivalent scale. Yet the morphine milligram equivalent point of reference has been cast in stone by statute in Arizona.

We shouldn’t need to change the statute with every new nuance we learn about how to treat pain.

I urge this Committee to remove the handcuffs it has placed on health care practitioners who treat pain. Thank you for providing me this opportunity to speak.