Naloxone, a drug designed to reverse opioid overdoses, is
finding its way into legislation across the United States as lawmakers hope to make
opioid antagonists widely available. Michigan is considering a bill
that would allow police officers to carry and administer opioid antagonists
without facing civil liability for using them. New Jersey’s A 3838
would authorize public libraries to maintain a supply of opioid antagonists and
permit librarians or other trained employees to administer them.
More orthodox legislation includes the District of
to address opioid overdoses by allowing physicians to prescribe, and pharmacists
to dispense, opioid antagonists to a person at risk of or having an overdose or
to a friend or family member of the person at risk. In Rhode Island, the
Department of Health plans to amend its rules
to require Naloxone to be co-prescribed with any opioids that amount to more
than 90 morphine milligram equivalents or when prescribing to an individual
with a history of opioid use disorder.
Delaware’s SB 176,
introduced on April 25, establishes the Prescription Opioid Impact Fund to pay
for addiction treatment and prescription monitoring. The fund would be
supported by a Prescription Opioid Impact Fee of $0.01 per morphine milligram
equivalent sold by manufactures.
Wisconsin’s Controlled Substance Board proposed new rules
excluding Naldemedine, an opioid antagonist, from the controlled substances schedule.
The bill aims to bring Wisconsin’s schedule in line with the federal Controlled
Substances Act, and although the bill excludes Naldemedine alongside other
opioid antagonists like Naloxone, the rules do not specifically mention the
drug’s role in addressing overdoses in the Board’s justification.
TennCare, which administers Tennessee’s Medicaid system,
proposed new rules
limiting opioid doses for recipients in different categories. The rules make a
distinction between “chronic opioid users,” who have received at least a 90-day
quantity in 180 days, and “non-chronic opioid users,” who have been prescribed
amounts below this threshold. Nonchronic opioid users are restricted to 15-day
dosages in a six-month period and cannot exceed 60 morphine milligram
equivalents per day. Exceptions are made for enrollees undergoing palliative
cancer treatment or suffering from Sickle Cell Disease.
TennCare hopes this will allow patients with chronic need for
pain management to get appropriate care while limiting the supply for people
with less need.
2504, currently referred to its House Committee on
Health, would make a number of amendments to the state’s prescription drug
monitoring program. It would require reporting of data on the distribution of
opioid antagonists and overdoses. It also clarifies that the monitoring body,
the Achieving Better Care by Monitoring All Prescriptions (ABC-MAP) board, must
attempt to identify at-risk individuals and provide education about alternative
Nevada Dental Board
to Deem Fraudulent Prescribing Unprofessional Conduct
The Board of Dental Examiners of Nevada proposed new rules
on April 6 adding new acts to its definitions of unprofessional conduct. If
adopted, the rules will designate any fraudulent prescription, use or
possession of controlled substances as unprofessional conduct worthy of
complaint and investigation.
Technology Used to Improve Prescription Drug
The University of
Maryland School of Dentistry, which sees itself as the state’s largest dental
provider, hopes to use technology to make a dent in the opioid epidemic. The
school is partnering with DrFirst, a tech company in Rockville, MD, to implement its mobile prescription
tracking and private messaging platform in its clinics, which serve around
26,000 patients. The mobile app will be available to clinicians, students and
alumni, making easy compliance with Maryland’s Prescription Drug Monitoring
Program. By changing the way its faculty and students approach prescription,
the University of Maryland is making sure the current and next generations
learn to keep fewer pills in circulation.
Advising Patients on
Rhode Island and Alaska have both introduced bills requiring
providers to discuss the risks of opioid abuse with patients before prescribing
them opioids. Alaska’s HB 268, currently
sitting in the House Rules Committee, directs licensing boards to require
licensees to inform patients of the risks of opioid use and any available
alternatives to opioid prescription.
Rhode Island’s S 2784, currently
being studied in committee, requires health care professionals to advise
patients on the risks of opioid dependence—including overdose—before
prescribing opioids. The provider must discuss alternatives to opioids after
the second and/or third prescription refill.
Maryland’s legislature passed, and the governor has yet to
sign, HB 653, which
mandates that patients must be advised of the risks and benefits of opioid use
or the use of benzodiazepine along with opioids.
Considers Adding Nonopioid Alternative CME Requirements
Minnesota is considering HF
95, which would add two hours of required continuing
education on nonpharmacological alternatives to opioids for dentists authorized
to prescribe them.
these coincide with Congressional and state efforts to address the opioid
epidemic by looking at providers and prescriptions. If the crisis is rooted in
the path from prescription to addiction to abuse of illegal drugs like
fentanyl, then a sensible way forward starts with providers. During two
hearings in April, the House Energy and Commerce Committee Subcommittee on
Health discussed the importance of educating providers through continuing
medical education (CME) and graduate medical education (GME). Witnesses from
medical centers and insurers explained to members that providers needed to
learn more about alternative methods of pain management as well as how the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) allows
a Senate Finance Committee hearing on the opioid epidemic, Admiral Brett
Giroir, M.D., representing the Department of Health and Human Services,
recalled that he was never taught that there were any downsides to prescribing
opioids while in medical school. The entire burden of the opioid crisis cannot
fall on providers; however, dentists and other providers can improve outcomes
for potential addicts by changing the culture around pain management.