State takes aim at opioid crisis

In an effort to tackle the opioid addiction epidemic, state legislators, Attorney General Bob Ferguson, and Democratic Governor Jay Inslee are rolling out legislation to limit opioid prescriptions and invest in drug treatment infrastructure.

On Jan. 12, the House Committee on Healthcare and Wellness heard public testimony on two bills that would limit the quantity of opioid pain medications that doctors and other providers can prescribe patients who are obtaining opioids for the first time—patients over the age of 21 could receive no more than a seven-day supply while those under 21 could obtain only a three-day dosage—and require that prescribers of opioids enroll in a state program to gather data and monitor opioid distribution to prevent over-prescribing.

The former bill would also require that providers notify patients obtaining more than a three-day supply of opioids of the risk of addiction.

While supported by the family members of those who have suffered from opioid addiction and law enforcement and public health officials, the bills were opposed by some worried about access to their pain medication as well as lobbyists for the medical community who were concerned about the burden it would put on doctors.

Both bills were requested by Ferguson, who argues that the limitations are necessary to prevent patients from getting addicted and keep excess pills out of medicine cabinets and in the hands of non-patients, and to make sure that all providers of opioids participate in the state’s Prescription Monitoring Program, which tracks patient prescription histories.

“The overprescribing of opioids has contributed to this problem which has swept across our state,” said Ferguson. “Despite the attention that this issue has received, over-prescribing is still happening.”

Only 35 percent of opioid providers in Washington currently participate in the voluntary Prescription Monitoring Program, according to Chris Baumgartner, drug systems director at the state Department of Health.

Gov. Inslee is moving on opioids as well: He’s requested a bill that prioritizes medication-assisted treatment—such as buprenorphine—for people suffering from opioid-use disorder, places medication treatment services at contact points such as prisons and syringe exchanges, and a first-in-the-nation Medicaid waiver to allow incarcerated individuals suffering from addiction to receive treatment.

His supplemental budget also calls for investing roughly $15 million in medication-assisted treatment—including setting up drug treatment services at contact points such as jails. Additionally, Inslee wants another $4 million for “prevention,” such as youth prevention efforts in rural communities.

Specifically, the governor wants to increase the number of individuals in treatment by 20 percent each year over the next two years, a benchmark he called a “aggressive goal.”

“Two Washingtonians a day succumb to and lose life as a result of opioid addiction. And that is unacceptable,” Inslee said. “The state needs to step up.”

Starting in the early 2000s, reported deaths from prescription opioids rose dramatically before peaking in 2008, while deaths from heroin skyrocketed starting in 2010, according to state Department of Health data. Deaths from fentanyl—a prescription opioid pain medication that is significantly more powerful than heroin—have increased since 2015 as well. In 2016 alone, 694 people died from opioid overdoses, 446 of which were from prescription drugs.

However, the state experienced fewer fatal overdoses over the first half of 2016 than in the first half of 2017, and prescription opioid deaths have fallen since their peak in 2008, according to Baumgartner with the Department of Health.

The governor and attorney general have emphasized over-prescribing of opiates by providers as being a major driver of opioid addiction in the state.

According to a report compiled by the Attorney General’s Office, Washington dentists prescribed the most opioids—roughly 13,000 pills for 13-19 year-olds during a six-month period in 2015—followed by emergency medicine providers. The report also indicated that Washington counties that experienced high prescription rates generally saw overlapping high rates of opioid overdoses in recent years.

However, the proposals aren’t without opposition. While the governor’s bill was relatively well received during a Senate public hearing earlier this week, the attorney general’s bills to limit opioid prescriptions and force providers to participate in the state’s monitoring program garnered significant pushback from the medical community and individuals suffering from chronic pain.

“Prescriber fear is at an all time high in our state,” said Cyndi Hoenhous, a member of Washington Patients in Intractable Pain, at a House hearing on Jan. 12.  “When it comes to opioid policy right now, providers don’t care about patients like me. Those in pain are now a liability.”

Katie Kolan, with the Washington State Medical Association, criticized the prescription monitoring mandate as redundant. The Health Department already has a stakeholder group discussing how to bring more providers into the monitoring program and general rules for prescribing opioids, she said. “While well-intentioned, this measure is duplicative and disruptive to efforts done by the state currently to implement the rule making and would preempt the department’s rule-making authority,” she said.

Another Washington State Medical Association representative and former state senator, Nathan Schlicher, said that poor integration of the monitoring program with the electronic health records system is burdensome for medical staff. “It’s bureaucracy as its finest,” he said, going on to call the program “poorly designed” and “poorly integrated.”

“If we do mandates like this it does take time away from patients,” Schlicher added.

“We’re not ready for a mandate on this,” said Mellani McAleenan, a representative with the Washington State Dental Association.

Notably absent from the committee hearings on Ferguson’s restrictions on opioid prescriptions were pharmaceutical interests. However, PhRMA, a national association representing pharmaceutical companies including Purdue Pharma—the company that aggressively marketed oxycontin to the medical community and downplayed its addictive qualities in the 1990s and early 2000s, according to reporting by The New Yorker—supports the legislation and won’t be lobbying against either bill.

“We recently announced our support for policies that limit the supply of opioids to no more than seven days for patients with acute pain, a significant step for our industry … We also support strengthening and improving the state-run electronic databases that track prescribing of controlled substances,” a PHrMA spokesperson said.

Attorney General Ferguson is currently suing Purdue Pharma for deceptive marketing practices.

    People testifying in support of the attorney general’s bills had passionate responses to the concerns of patients in chronic pain and the medical community.

“It’s ridiculous. Honestly, this is the worst man-made epidemic in modern medical history and we’re talking about how much time it takes,” said Gary Franklin, the Department of Labor and Industries Medical Director. “These drugs are potentially deadly.”

“I know that these bills aren’t going to end this crisis but they can stem the flow of diversion if medicine cabinets aren’t full of leftover pills,” said Brenda Zane, whose 19-year-old son recently overdosed on fentanyl and survived. “I’ve heard alot about inconvenience and burdens … how about $150,000 in medical costs? Those are burdens that I’m carrying. And my son lived … So we’re the lucky ones.”