Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States Kelly Murphy Program Director, Health Division National Governors Association January 2017
Purpose of this Session Provide a brief overview of the national opioid crisis Provide a brief summary of NGA’s work with states Highlight sections from Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States 2
Spread of the Opioid Crisis U.S. Map of Opioid Death by State, 1999 - 2014 1999 DRUG OVERDOSE DEATH RATES 2002 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES 2005 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES 2008 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES 2011 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES 2014 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES 2014 RAPID INCREASE IN DRUG OVERDOSE DEATH RATES Source: Centers for Disease Control and Prevention
Illicit Fentanyl 4
Realities of the Opioid Crisis • This crisis is impacting constituents lives: • It is a bipartisan issue (impacting red, blue, and purple states) • It is urban and rural • It affects people of all ages • It affects people of all income levels and socioeconomic status • It is an economic issue, with consequences for health care costs, lost productivity, and jobs and hiring within communities • The solutions are not simple: • Strategies may be slow to show results • Several factors are compounding states’ progress • Greater availability of heroin • Spread of illicit fentanyl • Data lag • There is a lack of evidence for effective strategies • Stigma surrounding opioid use disorder is changing • States are viewing the problem as a public health crisis, rather than solely a public safety issue 5
Timeline of NGA Activities • Joint effort between Health and Homeland Security and Public Safety • 2012 – 2015: NGA convened two prescription drug abuse policy academies with 13 states • Round 1: Alabama *, Arkansas, Colorado *, Kentucky, New Mexico, Oregon and Virginia • Round 2: Michigan, Minnesota, Nevada *, North Carolina, Vermont * and Wisconsin *denotes policy academy co-lead governor • February 2016: During the NGA Winter Meeting, governors agreed that collective action is needed to end the opioid crisis • Summer – Winter 2016: • 46 governors sign Governors Compact to Fight Opioid Addiction • NGA released Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States • Launched Three Learning Labs: New Jersey, Rhode Island and New Mexico • Launched monthly Opioid State Action Network (OSAN) Calls • Publications: • Six Strategies for Reducing Prescription Drug Abuse . (September 2012) • Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy ( February 2014) • Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States. (July 2016) 6
Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States 7
Opioid Road Map Highlights: Key Factors 8
Opioid Road Map Highlights: Comprehensive Policy Framework 9
Opioid Road Map Highlights: Select Health Care Strategies • Prevention : • Develop and update guidelines for all opioid prescribers • Limit new opioid prescriptions for acute pain, with exceptions for certain patients • Develop and adopt a comprehensive opioid management program in Medicaid and other state-run programs • Remove methadone for managing pain from Medicaid preferred drug list • Treatment and Recovery: • Change payment policies to expand access to evidence-based Medication Assisted Treatment (MAT) and recovery services • Increase access to naloxone • Expand and strengthen the workforce and infrastructure for providing evidence-based MAT and recovery services • Create new linkages to evidence-based MAT and recovery services 10
Opioid Road Map Highlights: Select Public Safety Strategies • Reducing Illicit Supply and Demand for Opioids: • Establish a collaborative information sharing environment that breaks down silos across state agencies to better understand trends • Leverage assets from partner entities to improve data collection and intelligence sharing to restrict the supply of illicit opioids • Expand statutory tools for prosecuting major distributors • Expand partnerships and data access to better target overprescribers • Responding to the Crisis: • Empower, educate and equip law enforcement personnel to prevent overdose deaths and facilitate access to treatment • Reinforce use of best practices in drug treatment courts • Ensure access to MAT in correctional facilities and upon reentry into the community • Strengthen pre-trial drug diversion programs to offer individuals the opportunity to enter into substance use treatment 11
State Trends in Opioid Work • Increased use of data to track the problem • Tracking fatal and non-fatal overdoses • Increasing pill limits, prescribing guidelines • Increasing access to treatment via peer services, community providers • Broadening naloxone access and Good Samaritan immunity laws • Refining and improving PDMPs • Engaging schools — opioids in health education, school nurses access to naloxone • Implementing pre-trial diversion programs and increasing MAT for justice- involved populations • Increasing affordability of coverage for MAT, counseling and other wrap- around services • Working with providers on medical school education • Reducing stigma around addiction 12
Statutory Prescription Opioid Limits STATE SUMMARY KEY DATES Connecticut Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for minors. Bill enacted March 2016. Pill limit Permits documented exceptions for chronic and cancer pain, palliative care, substance use effective July 2016. disorder treatment and clinical judgment. Public Act No. 16-43 (see Section 7) Maine One-hundred morphine milligram equivalent per day limit for any opioid or opioid combination Bill enacted April 2016. Pill limit prescription. Thirty-day limit on opioid prescriptions for patients with chronic pain. Seven-day effective January 2017. Dosage limit for acute pain. Exceptions for cancer pain, palliative care, end-of-life hospice care, limit effective July 2016 for new treatment for opioid use disorder and other circumstances determined through agency patients and July 2017 for patients rulemaking. Permits documented exceptions to dosage limits until January 2017 or until with active prescriptions. agency adopts rules. Public Law 2015, Chapter 488 (see Section 2210) Massachusetts Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for minors. Bill enacted March 2016. Limits Permits documented exceptions for chronic and cancer pain, palliative care, substance use effective immediately. disorder treatment and clinical judgment. M.G.L. ch.94C (see Section 19D) New York Seven-day limit for opioid prescriptions for acute pain. Limit does not apply to prescribing for Bill enacted June 2016. Limit chronic pain, cancer-related pain, hospice or other end-of-life or palliative care. Assembly Bill effective July 2016. A10727 (see Part C) Pennsylvania Seven-day limit on opioid prescriptions to minors with exceptions for chronic pain, palliative or Bill enacted November 2016. hospice care, or when practitioner documents medical necessity and indicates that a non- Limits for minors effective upon opioid alternative was not appropriate. Additional restrictions on first-time prescribing to minors. publication of required notice. P.L. 983, No. 125 Limits for emergency departments effective 60 days after enactment. Seven-day limit on opioid prescriptions to patients in emergency departments, except when practitioner documents medical necessity and indicates that a non-opioid alternative was not appropriate. patients in emergency departments. P.L. 976, No. 122 13
Opioid Road Map Highlights: Finalize, Implement and Evaluate 14
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