STATES REACT TO OPIOID CRISIS

[Note:  This posting is a continuation of a report on the development of a civics unit of study.  This unit is directing students to formulate informed positions on the opioid epidemic.  Writer wants to express gratitude to Wikipedia for identifying the bulk of the research this blog has used in the development of this unit.[1]]

After sharing a short history and a list of factoids and insights regarding the opioid crisis/epidemic, this blog will now report on how government has reacted to the challenge opioids represent.  In true federalist fashion, this review will begin with a look at what the state governments have done.

          The main reaction has been legislation to block those prescribing protocols that have led to “high-risk” prescribing practices.  For example, there are now laws against doctors and clinics from prescribing the drug on long-term bases.  Summarily, there have been four categories of laws:

·        Laws mandating that those receiving prescriptions sign-up to a database record known as the Prescription Drug Monitoring Program (PDMP).  This is a statewide record and it includes the names of all patients who are being prescribed “controlled substance” drugs.

·        Laws mandating that anytime a prescriber – doctor or clinic worker – is about to prescribe an opioid, he/she is to check the PDMP.

·        Laws limiting the amount and duration over which these drugs can be prescribed.

·        Regulation laws that establish the necessity to monitor clinics – some known as “pill mills” – to drastically decrease the number of opioid prescriptions they issue.  This is particularly aiming at non-medical prescriptions.[2]

These developments should be added to the short history of the crisis already reported in this blog.

          As for factoids, the following is offered:

·        Governors of 45 states and 3 territorial governors organized themselves, in July 2016, to draw up an agreement, “Compact to Fight Opioid Addiction.”  The compact calls on the governors to coordinate their actions to help end the crisis.  This includes policies to address both governmental and private activities and protocols.  Special attention should be given to how the compact focuses on opioid producers and doctors.[3]

·        After the state of Maryland experienced about 2,000 deaths from opioid overdoses in 2016, the governor declared, in March 2017, a state of emergency.  Practically, that declaration meant coordination between state authorities and those of local jurisdictions.[4]

·        Other states that have introduced and/or enacted legislation to fight the opioid crisis have been Deleware,[5] Michigan, including instituting the Michigan Automated Prescription System (MAPS) which mirrored the efforts of PDMP,[6] Maine,[7] Utah,[8] West Virginia,[9] and Washington.[10]  Of special note, Texas officials are focusing their efforts on pill mills,[11] and Washington filed suit, in 2017, against Purdue Pharma for related negligence in their marketing activities associated with opioids.[12]

·        Another special case is that of Arizona.  There, early in 2018, Governor Doug Ducey signed into law the Arizona Opioid Epidemic Act.  This act makes available $10 million to treat those who have been victimized by the ill effects of the drug.  It also limits patients, with exemptions, to five-dose-prescriptions.[13]

As for generalizations, there seems to be two:

·        State governments have been moved to act, including the legislating of laws, by the numbers of overdoses, deaths, and costs their citizens have suffered because of the increased prescribing and consumption of opioid drugs.  Illustrative example is that of Arizona that suffered in the Phoenix area 3,114 overdoses from mid-June 2017 to the end of January 2018.  That situation led to the enactment of the Arizona Opioid Epidemic Act (see above).[14]

·        State action has seemed to have positive effects on controlling the prescribing of opioids as exemplified by both Florida (previously noted in this blog) and Texas.[15]

Next posting will pickup this review of state actions.

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[1] The writer also wants to state that where possible, he has checked the sources and has at times added to the listed research.

[2]  Emma E. McGinty, Elizabeth A. Stuart, Alexander G. Caleb, Colleen L. Barry, Mark C. Bicket, and Lainie Rutkow, “Protocol:  Mixed-Methods Study to Evaluate Implementation, Enforcement, and Outcomes of U. S. State Laws Intended to Curb High-Risk Opioid Prescribing,” Implementation Science, vol. 13, no. 1, accessed August 6, 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828404/ .

[3] “A Compact to Fight Opioid Addiction,” National Governors Association, July 13, 2016, cite no longer on-line AND Gale Pryor, “6 Ways States Are Fighting the Opioid Epidemic,” Athenainsight, May 19, 2017, accessed August 6, 2018, https://www.athenahealth.com/insight/6-ways-states-are-fighting-opioid-epidemic .

[4]  “Hogan-Rutherford Administration Declares State of Emergency, Announces Major Funding to Combat Heroin and Opioid Crisis in Maryland,” Office of Governor Larry Hogan, March 1, 2017, accessed August 6, 2018, http://governor.maryland.gov/2017/03/01/hogan-rutherford-administration-declares-state-of-emergency-announces-major-funding-to-combat-heroin-and-opioid-crisis-in-maryland/ AND Bill Turque, “Maryland Governor Declares State of Emergency for Opioid Crisis, The Washington Post, March 1, 2017, accessed August 6, 2018, https://www.washingtonpost.com/local/md-politics/hogan-declares-opioid-state-of-emergency/2017/03/01/5c22fcfa-fe2f-11e6-99b4-9e613afeb09f_story.html?utm_term=.b47c113320ff AND Pat Warren, “Gov. Hogan Announces Opioid Epidemic State of Emergency,” March 1, 2017, accessed August 6, 2018, https://baltimore.cbslocal.com/2017/03/01/gov-hogan-announces-opioid-epidemic-state-of-emergency/ .

[5]  “Delaware Lawmakers Tackle Opioid Addiction Epidemic,” March 23, 2017, accessed August 6, 2018, https://web.archive.org/web/20170324175427/http://www.newsworks.org/index.php/local/item/102456-delaware-lawmakers-tackle-opioid-addiction-epidemic?_topstory .

[6]  “Governor Snyder Rolls Out Plan to Fight Opioid Addiction,” WILX News, March 23, 2017, accessed August 6, 2018, http://www.wilx.com/content/news/Governor-Snyder-rolls-out-plan-to-fight-opioid-addiction-416981693.html AND Rick Pluta, “Snyder:  Efforts to Stop Opioid Abuse Aren’t Working,” BBC World Service, March 23, 2017, accessed August 6, 2018, http://www.michiganradio.org/post/snyder-efforts-stop-opioid-abuse-aren-t-working .

[7] Christopher Caldwell, “American Carnage:  The Landscape of Opioid Addiction,” First Things, April 2017, accessed June 18, 2018, https://www.firstthings.com/article/2017/04/american-carnage .

[8] “H. B. 299 Substance Abuse and Mental Health Act Amendments – Bill Text,” n. d., accessed August 7, 2018, https://le.utah.gov/~2017/bills/static/HB0299.html AND Alex Stuckey, “Poll:  Many Utahns Know People Who Seek Treatment for Opioid Addiction, but Barriers Remain,” The Salt Lake Tribune, April, 2017, accessed August 7, 2018. http://archive.sltrib.com/article.php?id=5110951&itype=CMSID .

[9] Scott Higham and Lenny Bernstein, “Opioid Distributors Sued by West Virginia Counties Hit by Drug Crisis,” March 9, 2017, accessed August 7, 2018, https://www.washingtonpost.com/national/health-science/lawsuits-filed-against-drug-distributors-in-west-virginia/2017/03/09/f9e3165e-0501-11e7-b1e9-a05d3c21f7cf_story.html?utm_term=.d34bb4da534a AND Ailsa Chang, “Lawyer behind West Virginia County Lawsuit against Opioid Distributors,” NPR, April 20,2017, accessed August 7, 2018, https://www.npr.org/2017/04/20/524936058/lawyer-behind-west-virginia-county-lawsuit-against-opioid-distributors .

[10]  Note:  this refers to a lawsuit filed by a city, Everett, Washington.  See “U. S. City Sues OxyContin Maker for Contribution to Opioid Crisis,” NPR, February 3, 2017, accessed August 7, 2018,   https://www.npr.org/2017/02/03/513196772/u-s-city-sues-oxycontin-maker-for-contributing-to-opiod-crisis .

[11] Tatyana Lyapustina, Lainie Rutkow, Hsien-Yen Chang, Matthew Daubresse, Alim F. Ramji, Mark Faul, Elizabeth A Stuart, and G. Caleb Alexander, “Effect of a “Pill Mill” Law on Opioid Prescribing and Utilization:  The Case of Texas,” PMC/US National Library of Medicine/National Institutes of Health, 2016, accessed August 7, 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976392/ .

[12] “U. S. City Sues OxyContin Maker for Contribution to Opioid Crisis,” NPR.

[13] Joan Magtibay, “Ducey Signs Sweeping Law to Confront Arizona Opioid Crisis,” Cronkite News, January 26,2018, accessed August 7, 2018, https://cronkitenews.azpbs.org/2018/01/26/ducey-signs-sweeping-plan-confront-arizona-opioid-crisis-law/ .

[14] Ibid.

[15] Tatyana Lyapustina, Lainie Rutkow, Hsien-Yen Chang, Matthew Daubresse, Alim F. Ramji, Mark Faul, Elizabeth A Stuart, and G. Caleb Alexander, “Effect of a “Pill Mill” Law on Opioid Prescribing and Utilization:  The Case of Texas.”