ADEA State Update

Prescription Abuse and the Opioid Crisis - May 2018

(State Policy, Opioid Abuse, Prescription Drug Abuse) Permanent link   All Posts

May2018OpioidNaloxone

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 Columbia’s bill 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 Opioid Impact Fund

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 Unschedules Naldemedine

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.

Tennessee Dosage Limits

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.

Pennsylvania Prescription Monitoring Program

Pennsylvania’s HB 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 treatment options.

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 Monitoring

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 Opioids

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.

Minnesota 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.

Efforts like 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 data-sharing.

Similarly, during 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. 

Duggan Dental