The US Senate unanimously passed Jessie’s Law on August 3, 2017, and the House of Representatives passed it by voice vote on June 12, 2018.
The US Senate unanimously passed Jessie’s Law on August 3, 2017, and the House of Representatives passed it by voice vote on June 12, 2018.1 As the bill moved through the legislative process, Jessie’s Law became part of a larger legislative proposal called the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT Act.2 President Donald J. Trump signed the bill on October 24, 2018.3,4 The bill was designed to address concerns about a history of opioid addiction leading to breaches in patient confidentiality or to undertreated pain. To date, Jessie’s Law has not been publicly opposed, which might be expected due to mandatory patient consent and emphasis on a team approach to pain management.
Jessie’s Law is named after Jessica Grubb, a Michigan resident who struggled with addiction for 7 years after being sexually assaulted during her freshman year in college. She turned to heroin to escape the trauma and was in and out of rehabilitation programs 4 times—until she finally found recovery and began turning her life around.
Six months into her recovery, while training for a marathon, she injured her hip, which led to an infection and a hospitalization. Grubb and her family alerted hospital staff to her history of addiction, explaining that she was a recovering addict and should not be prescribed opioids. Grubb’s history was recorded in her patient chart on 8 separate occasions.
Unfortunately, that information never reached the discharging physician. Despite Grubb’s transparency about her past medical history, she was discharged with 50 oxycodone tablets and an intravenous port to increase medication access. Upon returning home, she fatally overdosed on March 2, 2016, at the age of 30.5
This was not an isolated incident. In 2016, there were 63,632 deaths in the United States from drug overdose, with two-thirds involving an opioid.6
Jessie’s Law aims to avoid such tragedies by noticeably and prominently displaying vital health history information, thus ensuring that health care providers have all the information necessary to provide medically appropriate care. The purpose of the legislation is to give notification about a history of addiction, with patient consent, in a fashion similar to a medication allergy. For example, a patient with a history of opioid addiction being discharged with a prescription for an opioid would prompt an alert to the provider the same way as a patient with a sulfa allergy being discharged with a prescription for Bactrim. This hard-stop alert brings attention to the discrepancy and allows health care providers access to potentially life-threatening information.
It should be noted that the SUPPORT Act includes dozens of different provisions, all aiming to end the opioid crisis. The act affects every sector of the health care industry, from family medical practices to health insurance companies. Most importantly, the act affects patients. Perhaps the most significant impact of the act is that it removes restrictions for Medicaid and Medicare patients in need of opioid addiction treatment and aims to stop the overprescribing of opioid medications.
Pharmacists as patient caregivers will be particularly affected by this bill, as they are ultimately responsible for patients’ medication management. Jessie’s Law assists pharmacists in ensuring safe medication therapy and more accurate care through an “alert” prompted by a patient’s medical history. By assisting pharmacists in their roles, this law can help maintain patient safety while fighting the opioid epidemic.
The goal of the legislation is to have the patient’s history of substance use disorder recorded in the patient’s chart, just as would be done with any other life-threatening health condition, such as, say, an allergy to penicillin. The legislation seeks to prevent tragedies like Grubb’s death by ensuring that when individuals are open about their past addiction, health professionals have access to all the relevant information needed to provide appropriate care and save lives.
The alerts incorporated into patients’ health records should prove valuable in assisting pharmacists as they work toward their overarching goal of helping patients obtain optimal outcomes from use of medications. The legislation attempts to address the fact that the patient’s chart is the resource that serves as a repository for a wide range of information regarding the patient’s care and challenges. That can be both a blessing, as it is hopefully a complete collection of information, and a curse, as it can contain so much information that important things get overlooked, as was the case for Grubb.