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In order to simplify narcotic legislation, state laws should be patterned after the national narcotic law. In our February issue we printed the complete text of a proposed uniform state narcotic law based on the national law. If this state law were adopted in all the states, in conjunction with the national law, it would serve the purpose of controlling effectivly the narcotic evil. Further incursions into the practise of medicin by such laws would be unnecessary. The national law itself is achieving the results expected of it. In Philadelphia over a hundred and fifty drug addicts have applied to hospitals for treatment. The carrying out of the provisions of the bill produced great consternation among addicts, a number of whom finally were compelled to apply to hospitals and police authorities for assistance. Thus the need for and the usefulness of the national law is demonstrated. What happened in Philadelphia doubtless occurred all over the United States. Why then should other cumbersome laws be enacted to suppress an evil that is being properly supprest without them?
Any state law that would impose further burdens on the medical profession than is done by the national law would be an unwarranted imposition and should be vigorously opposed by the entire medical profession. There have been introduced into a number of state legislatures narcotic bills that would make a great deal of trouble to physicians of their respectiv states if enacted into law.
In Minnesota, for instance, House Bill No. 1 revises the present narcotic law and creates a law regulating the sale of cocain, alpha or beta eucain, morphin, heroin or opium, their salts, derivativs and compounds. This bill does not follow the federal law for separate records in the case of sales at wholesale, providing different minimum quantity exemptions, etc. No provision is made for dispensing by the physician. treatment of habitual users of these drugs is limited to the personal administration to the patient by a physician when it has been in good faith determined by two reputable and duly licensed practising physicians in consultation, to be absolutely necessary in the medical treatment of said patient. It is a very crudely drawn bill and not at all in harmony with the national narcotic law. It would compel the physician to write a prescription before dispensing. This bill was subsequently amended to include chloral, to require physicians to keep detailed records of dispensing, and to keep separate and detailed records of the treatment of habitués, etc.
Senate Bill, No. 7, limits the sale and giving away of opium, morphin, cocain, acetanilid, phenacetin, codein or any derivativ or compound of coal-tar or any preparation or combination containing the same or any habit-forming drug or preparation, except upon a written prescription of a physician.
Physicians of Minnesota must get busy very quickly if they want to stop the passage of these iniquitous bills. The legislature may have adjourned before now. It convened January 5th and was limited to a 90-day session.
In Kansas, House Bill, No. 306, was a very thoro narcotic, pharmacy and poison law and did not hinder physicians from dispensing medicin. It was urged for passage by Kansas doctors. House Bill, No. 804, was quite similar to No. 306. Senate Bill, No. 659, was a copy of the Boylan law of New York. The legislature has adjourned. Nebraska.
In Nebraska, Senate Bill, No. 61, was a complete narcotic law and not at all in harmony with the national law. It permitted administration but not dispensing, and treatment of habitués was like that described in the Minnesota bill. record of all treatment of habitués must be kept, subject to inspection by the State Board of Pharmacy, state health officers, etc. House Bill, No. 113, and Senate Bill, No. 7, were equally bad. House Bill, No. 125, was another very excessiv bill. In connection with the federal narcotic bill it would have more than doubled the labors imposed on the physician in treating the sick. The legislature convened January 5th and was limited to 60 days.
House Bill, No. 222, by Mr. Oakley, proposes a law similar to the New York Boylan law, and so would require the physician to make out separate order forms in addition to the federal order forms, in purchases, and would require a record in detail of all medical dispensing.
New Jersey has a number of bills before it. In their legislature, House Bill, No. 31, permits In dispensing by physicians without record. some respects the bill conflicts with the federal law, the exemptions being quite different. Such differences make confusion in attempting to follow two laws.
Senate Bill, No. 94, incorporates a complete narcotic law. Provision is made for official prescription blanks in which must be indicated, detailed information of each prescribing. Sales at retail are limited on the official prescriptions. Refilling of prescriptions is prohibited. The retail druggist must give to the consumer an official certificate indicating the identity of the drugs so sold. Official order blanks for all sales at wholesale are provided. The daily prescribing of these narcotic drugs for three weeks must be separately recorded, and only after consultation with another physician and official reports of such prescribing must be made to the local boards of health. The same procedure must accompany dispensing as prescribing; that is, a written prescription must first be made out and a certificate given to the patient. This is a very onerous bill and should be defeated by the united action of the physicians of New Jersey.
Assembly Bill, No. 123, is not in harmony with the federal law, the minimum exemptions differing. Dispensing by physicians is unrestricted.
New York has a number of bills to contend with in its assembly. Senate Bill, No. 493, introduced by Mr. Boylan, author of the Boylan law that has riled the physicians of that state, is an amendment to the Boylan law and defines the permitted sales at wholesale, but makes no express provision as to sales to the medical profession at wholesale, tho mentioning sales to manufacturers and dealers, which renders it confusing. The recording feature is made more elaborate and cumbersome. The Boylan law is mischievous enuf as it is without being made
that we advocate would include all narcotics and heroin. It is insufficient.
Senate Bill, No. 177, and House Bill, No. 329, propose a complete narcotic law. It embraces the fundamental features of the federal law, and in this respect is a very good bill. Medical dispensing is unrestricted, no record being required. The bill also prohibits the sale of any proprietary or patent medicins containing any of these narcotic drugs which is advertised or recommended as an infant remedy. This seems to be a good bill and worthy of the support of Pennsylvania physicians.
In North Dakota, Senate Bill, No. 67, limited the sale or giving away of preparations containing heroin on physicians' prescription. Prohibits the prescribing of heroin for an habitué. Prohibited a veterinarian or dentist from prescribing heroin for a human being and made a medical practician liable to a revocation of his license for a violation of this law.
House Bill, No. 379, required all medicins prepared, compounded or dispenst under a physician's prescription, recipe or formula to be labeled to indicate the contents and ingredients.
House Bill, No. 69, prohibited the druggist or physician from giving or prescribing opium, morphin, cocain, etc., to a chronic addict to the use of these drugs, except in an emergency, without consultation with another physician. The bill also provided that as soon as a druggist or physician discovers such an addict he must immediately report him to the state attorney, and the latter must immediately arrest such addict, who must then be brought before the Insanity Board, and if such board determins, after examination, that the person is a chronic user of such drugs, the board shall commit him to a hospital or other proper place for detention and treatment until cured. This manner of apprehending drug addicts reminds us of the method of "denouncing" political opponents during the French revolution, which afforded an easy method of getting certain people removed. Similar methods have been followed in Russia until a very late period.
The uniform state narcotic law should be enacted in North Dakota instead of these bills. The legislature convened January 5th and was limited to 60 days.
In Ohio, House Bills, Nos. 305 and 390, are splendid uniform state narcotic laws and deserve the support of everybody and the emulation of all other legislatures. Ohio physicians should see that they are passed. House Bill, No. 132, intrusts enforcement of narcotic law to the Board of Pharmacy.
In South Carolina, House Bill, No. 159, requires that dispensing of opium or its derivativs by a physician be made only upon a prescription. This prohibits dispensing. The uniform state law should be enacted instead.
In South Dakota, House Bill, No. 49, was a narcotic law not in harmony with the national law. The minimum quantity exemptions were different. Physicians could dispense only on a detailed written prescription. Senate Bill, No. 23, was also a narcotic law. No record of medical
dispensing was required. Special registration books must be kept by the dealer and physician, showing the purchases and sales. These bills should have been rewritten to conform to the national narcotic law. The legislature convened January 3d for a 60-day session.
In Texas two very objectionable bills were before the legislature. Senate Bill, No. 96, was a narcotic law not in harmony with the federal law. Medical dispensing was limited upon prescriptions, and physicians could not fill their own prescriptions in towns and cities of 2000 or more inhabitants. House Bill, No. 170, was a similar bill. These bills should have been defeated. The legislature met January 5th for a 60-day session. Vermont
In Vermont, House Bill, No. 68, is not at all in harmony with the national narcotic law. It is similar to the Massachusetts narcotic law of 1914. A record of every medical dispensing is required.
In West Virginia, House Bill, No. 201, and Senate Bill, No. 151, were similar to the Boylan law of New York and should have been defeated. The legislature met January 13th for a 45-day session.
In Arkansas, House Bill, No. 154, was not in harmony with the federal law. Medical dispensing would be limited upon written prescriptions. The legislature met January 11th for a 60-day session.
In Connecticut there has been introduced into the legislature, a bill requiring all physicians, dentists and veterinarians to keep a record of the name, address and quantity of every single dispensing. Violation of this law subjects the physician to the liability of the revocation of his license. House Bill, No. 797, will require a physician to be a licenst pharmacist.
In Iowa, House File, No. 252, prohibits the refilling of opium and cocain prescriptions or of any prescription markt not to be refilled. Prohibits any person from selling or distributing opium or cocain or their derivativs, except upon the written order of a physician. This would limit dispensing upon written prescriptions only. Senate Bill, No. 71, and House Bill, No. 65, require every person selling or dispensing medicins on prescription to keep a book or file for the preservation of the originals of every prescription. All containers must be labeled accordingly.
House Bill, No. 326, is an admirable uniform state narcotic law, exactly harmonious with the national law. Therefore it should be supported by everybody and copied by all state legislatures. Idaho.
In Idaho, House Bill, No. 249, was a complete narcotic law and included chloral hydrate. Retail druggists were prohibited from disposing of these drugs, except to physicians and upon prescription. Prescriptions must be retained for one year and could be refilled on a written order from the physician. The doctor could furnish or administer these drugs to or for his patient and
to none other. It was lawful for a retail druggist to sell proprietary preparations containing not more than 4/10 per cent. of opium, % grain morphin, % grain heroin, 10 grains chloral hydrate and the label must show clearly the percentages of such articles contained therein. Violation of this act by the druggist or physician would ipso facto make it unlawful for him to practise his profession in Idaho "forever thereafter." The legislature convened January 4th for a 60-day session.
In Oregon, House Bill, No. 114, required physicians' prescriptions to be issued in triplicate and to contain the English name and equivalent for each medical term or symbol (not in the English language), where the English language shall have such name or equivalent, unless the prescription is issued wholly in English. The prescription must also contain the name of the person to or for whom it is issued and a plain, concise statement of the disease for which issued and the primary, direct physical or mental effect sought to be obtained. The original must be retained on file. Two copies were to be given to the person to or for whom the prescription is issued. North Dakota had a similar bill in its legislature. House Bill, No. 135, in Oregon, was a narcotic, pharmacy and poison law. The peddling of drugs was prohibited. The narcotic provisions varied radically from the national law. Dentists may not prescribe narcotics. Legitimate medical dispensing is entirely exempted. The legislature met January 12th for a 40-day session.
In Utah, House Bill, No. 79, was a new and complete poison and narcotic law, somewhat similar to the present California law. The sale of corrosiv sublimate tablets at retail was prohibited except on a recorded sale. Copies of all orders for the narcotic drugs specified, must be mailed within 24 hours to the State Board of Pharmacy. Physicians must report daily__treatment habitués to the State Board of Pharmacy. The minimum quantity of narcotic exemptions_was different from that of the federal law. Physicians could only dispense narcotics on a written prescription.
House Bill, No. 78, required the proprietor of every business where drugs are sold or dispenst to register annually with the State Board of Pharmacy. The legislature convened January 11th for a 60-day session.
In Montana, House Bill, No. 191, permitted physicians to dispense and did not require recording of drugs. The legislature convened January 4th for a 60-day session.
Nebraska (House Bill, No. 195), was legislating the balm out of embalming fluids, by prohibiting arsenic therefrom, while New Jersey (House Bill, No. 339), is legislating arsenic back into it.
Oregon (House Bill, No. 114), and North Dakota (House Bill, No. 339), were considering compelling the physician to write prescriptions in triplicate and in English, one copy to be kept by the physician, one by the patient and one by the druggist. On the contrary are certain laws that aim to prevent a patient from having a copy of his prescription, especially one for narcotic
drugs. What will the physician do where the laws conflict?
All sorts of shapes are being required for antiseptic tablets. Uniformity of shape and color or some latitude in these respects should be included before such bills are passed.
In Oregon (House Bill, No. 225), they were attempting to legislate arsenic and cocain out of dentistry; in California (House Bill, No. 190), arsenic, cocain and alpha and beta eucain are to be prohibited in dentistry.
The space that we can devote to this extensiv subject is too small to permit us to discuss these bills in detail. We can only give a few salient points of each. Among the objectionable features to be noted are those which prohibit dispensing, require elaborate recording of drugs dispenst, require an additional order blank to the one prescribed in the national narcotic law,* place the supervision of physicians in the hands of a board of pharmacy, require reports to a board of pharmacy, require the physician to get an annual license as a pharmacist, etc. The State Board of Health, and not the Board of Pharmacy, should receive physicians' reports. It is manifestly a mistake to place physicians under the surveillance or control of a board of pharmacy.
A worthy uniform state narcotic law was pending in Iowa, Colorado, Kansas and Ohio and the physicians in those states should see that they are enacted without amendment. It may mean trouble to the physicians if it is not passed.
We have stated our position on these points in THE WORLD during the past eighteen months and suggest you read them. Then get after each and every member of the legislature and insist that the uniform state narcotic law that we publisht in our February issue be passed as printed for reasons given in February WORLD. Write to us for a copy of the law in pamphlet form to send to your legislature. In the few states above noted, where a satisfactory law is in the legislature, urge its passage and do not let up in your urging until it has passed. Do not be content with anything else. Be insistent and persistent in your endeavors. Only thus will you succeed. Remember that the druggists are looking after their end of the bills, whereas the physicians are dependent on themselves. Many of the medical societies have not yet gotten activ in this matter.
*How will a doctor or druggist write two orders for one thing-using a state form and also a national form? Which is the true order, and which the spurious one?
Many physicians who do not dispense will not care what laws are passed that are troublesome for dispensing doctors. So it behooves every dispensing doctor to attend to the bills in his own state legislature as if he were the only physician looking after the interests of the profession in that matter. It will do any physician a great deal of good to write a lengthy letter on this subject in support or condemnation (as the bill warrants) to his state senator and representativ. Do not delay your action. Do it now.
BUSINESS TALK TO DOCTORS
When these lines reach you, spring will be making her gentle approach in many parts of this great country. How does it find you in a business way? Perhaps you need rest after a strenuous winter. But don't neglect to send bills for services rendered when perhaps you were too busy to send bills. And send statements to all who owe you, with a gentle reminder. you have been too busy to attend to financial affairs during the hard winter months, say so; and explain that you attend to the needs of your patients first, and then look after your own needs. You have been faithful to them, and now they should be faithful to you.
However, your rule should be to present the bill as soon as a given case is completed, and send statements on the first of every month until it is paid. That is the way business men do. And when you neglect doing that, because of unusually taxing work during winter or for any other
reason, make an extra occasion of it and mention the fact, as above suggested, the next time you send out bills and state
Don't let accounts get old. They rapidly decrease in value. Get the money and put it in bank. Then it does not decline in value, and you have it "on tap" for any need. Here is a brother who comes forward at this opportune time to help you:
CLOQUET, MINN., Feb. 16, 1915.
DEAR DR. TAYLOR:-It has been some time since we have had anything about form letters, "followups," etc., and I am taking the liberty of inclosing a series of slips which I have had my printer make for me; they speak for themselves.
I keep a case record, loose leaf, and each time a statement or slip is sent out the date is entered in the record and the number of the slip noted;
in this way I keep track of the sequence and do not double up. They bring in the money without ruffling the patient and usually he comes in with an apology for his delay unless he is a dead-beat; of course this class of patients are immediately made peevish upon receipt of the first bill and usually begin to dodge you on the street. I waste no postage on them and if a judgment is collectible, I sue for it.
Thinking this may help some one out, I am
ALEXANDER BARCLAY. The Doctor incloses a set of five slips, printed in plain type on paper of different colors, with a small number, 1 to 5, at the bottom of each. No. 1 is white, 2 salmon, 3 pink, 4 yellow and 5 blue. Here is the text on each, in consecutiv order:
I try to send out statements the first of each month for services rendered.
In addition to the practise of my profession, I am my own hired man, bookkeeper, etc., and my time is not always my own. I find that I make mistakes in making and sending out statements, as happens occasionally with us all.
If you have received a former bill you will understand the statement enclosed and this note; if not, this will explain the reason for my seeming negligence.
The keeping of accounts, sending out repeated statements and collecting of hundreds of old bills, I find, is the hardest part of the practise of my profession.
Doubtless you do not appreciate this.
My time is not always my own, I am busy caring for the sick, I lose much sleep, my hours for meals are irregular and I work hard for all I earn.
It is not right that a doctor must earn his fees many times over in collecting the account long after the memory of the service rendered is gone.
I think this is the third or fourth statement I
have sent you. Please come in and arrange to
settle the account.
I have sent you several statements of your account and you have paid no attention to them. What would you think of a doctor if you sent for him repeatedly in times of need and he paid no attention to you?
I send out bills because I need the money. When I get a ton of coal I have to pay for it; when I order a bushel of potatoes or a sack of oats it would not be delivered unless the storekeeper KNEW he was going to be paid for it. I have to pay мy bills to keep my credit good.
Don't you have to do the same?
Keep your credit good with your doctor as you never know when you may need him. He will attend you if you are known to be "good for it," even if you have no money in the house. If you can't pay the account in full, come in and see me
The laws of this state permit a doctor to sue an account and obtain judgment. All the court costs are added to the original bill and must be paid by the debtor.
A judgment when entered takes precedence over a garnishment no matter how large or small the amount, and your wages can be collected at any time until the judgment with all court costs attacht is satisfied.
Judgments may at any time be advertised in the newspapers for sale with details plainly set forth. What you do with this account in the next thirty days determins my actions in the matter after that.
A Missouri brother asks about some sort of colony advertised by a man named Lewis. The Doctor is 79 years old and does not want to sacrifice his little home, but his wife wants to go. He says the advertising is very alluring. Colony advertising always is alluring, but the reality is very different. Few things are as cruel as to allure people away from comfortable homes, rob them of all they have and dump them down amid the hardships of an undevelopt community. Colonies have never succeeded except when based on some religious fanaticism. The Shakers are an example of the latter. Secular colonies have always failed.
The "Hercules Oil Corporation," of Ada, Okla., "is financed principally by druggists, doctors and dentists." This is quoted from their circular letter, which is headed "Dear Doctor." Dr. W. A. Howard, secretary and treasurer of the Howard County (Okla.) Medical Society, got one of these letters, which he sent to me, with the following comment: