Nebraska Attorney General Doug Peterson has issued an opinion saying that doctors won't be disciplined for prescribing unproven or controversial treatments for COVID-19, as long as they have the informed consent of patients.
The opinion, which was issued Friday, specifically covers ivermectin and hydroxychloroquine, but it's likely it would apply to other potential "off-label" treatments for the disease.
The 48-page opinion, signed by Peterson and two staff members, mentions "significant controversy and suspect information about COVID-19 treatments." It cites as an example an article last year in The Lancet, a British medical journal, that found no benefit from hydroxychloroquine that was later retracted because of alleged fraud by the principal authors.
Because of conflicting data on the treatments, "We find that the available data does not justify filing disciplinary actions against physicians simply because they prescribe ivermectin or hydroxychloroquine to prevent or treat COVID-19," the opinion said.
The opinion was sought by the Nebraska Department of Health and Human Services, although it's not exactly clear why.
The department declined to comment on the reason it sought the opinion, saying in a statement that it, "appreciates the AG’s office delivering an opinion on this matter. The document is posted and available to medical providers as they determine appropriate course of treatment for their patients."
Health and Human Services CEO Dannette Smith said in her letter requesting an attorney general's opinion that consumers and doctors have been inundated with information about COVID-19 treatments, and “it may become difficult to discern the quality or validity of the information,” raising questions about what doctors can legally prescribe.
It's not clear if any complaints have been filed against any health professionals for prescribing the medications. In Nebraska, the state Board of Health can recommend discipline of a physician or other health professional, but the Attorney General has the final say.
The two drugs have been touted by some health professionals but more often by politicians and celebrities as potential cures of or prevention against COVID-19 infections.
Ivermectin is an anti-parasitic drug that can be prescribed for humans but is more commonly used in animals. Hydroxychloroquine is commonly used to treat malaria, but it also is used in the treatment of lupus and rheumatoid arthritis.
The Food and Drug Administration had at one point last year given emergency use authorization for the use of hydroxychloroquine in some limited cases in hospitalized patients after the drug showed initial promise as a treatment for the disease, but it later revoked that authorization after a large clinical trial "showed no benefit for decreasing the likelihood of death or speeding recovery."
Likewise, recent clinical studies of ivermectin have found it to have little or no clinical benefit in COVID-19 treatment, although it is on a National Institutes of Health list as an approved or under-evaluation antiviral treatment.
In a joint statement last month, the American Medical Association, the American Pharmacists Association and the American Society of Health-System Pharmacists said they strongly oppose the use of ivermectin as a COVID-19 drug outside of a clinical trial.
“We are alarmed by reports that outpatient prescribing for and dispensing of ivermectin have increased 24-fold since before the pandemic and increased exponentially over the past few months,” the groups said.
It does not appear either of the drugs is in wide use in Nebraska.
CHI Health, which owns more than a dozen of the state's hospitals, including St. Elizabeth in Lincoln, not only does not use ivermectin or hydroxychloroquine in the treatment of COVID-19, its pharmacies also won't fill prescriptions for the drugs to be used in treatment of the disease, said CHI Health spokeswoman Taylor Barth Miller.
Dr. Les Spry, a Lincoln kidney specialist who is on the Lancaster County Medical Society board, said he has heard there are local doctors prescribing one or both drugs to patients.
The Medical Society discussed the issue recently and expressed concern about the possible use of the drugs.
"A lot of the concern was that this was going to reflect poorly on the community," said Spry, who served eight years on the state Board of Health in the early 2000s.
However, he said he was not aware of any formal complaints being lodged against any doctors or other health professionals for prescribing the drugs.
Off-label use of drugs means using them for a purpose they are not FDA-approved for. It is a common practice and something Spry said he does several times a week.
But he said that in his opinion, the clinical evidence available does not support prescribing either ivermectin or hydroxychloroquine for COVID-19.
"There's not enough evidence of efficacy or safety for either of these drugs," he said.
The Attorney General's office seems to disagree, however.
"Allowing physicians to consider these early treatments will free them to evaluate additional tools that could save lives, keep patients out of the hospital and provide relief for our already strained health care system," the opinion said.
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The Associated Press contributed to this story.