Wednesday, November 23, 2016
Attorney General Issues Opioid Report Making Policy and Legislative Recommendations to Address Prescription Painkiller Abuse
Attorney General Lori Swanson today issued a report on opioid prescription painkillers that makes wide-ranging legislative and policy recommendations to improve and build on Minnesota’s response to the growing prescription painkiller epidemic.
“Growing addiction to prescription opioid painkillers is devastating families from all walks of life across all parts of our state. We need all hands on deck to push forward solutions, which must involve those in health care, the criminal justice system, patients, families, and policymakers,” said Attorney General Swanson.
The Report, entitled “Opioids: Preventing and Addressing Prescription Drug Abuse,” notes that the United States has less than five percent of the world’s population but uses 80 percent of the world’s painkillers. Prescription opioid painkillers are controlled substances that are sold under brand names like OxyContin, Percocet, or Vicodin. In 2012, 259 million painkillers were prescribed in the United States, enough for every adult to have a bottle of pills. The Centers for Disease Control has called prescription drug abuse the fastest growing drug problem in the United States.
Sales of opioid painkillers have quadrupled since 1999 and so have the number of overdoses from prescription opioids. Nearly 2 million Americans are estimated to be addicted to prescription painkillers. More than 40 people die every day in the U.S. from a prescription opioid overdose. Every 25 minutes a baby is born in this country with opioid withdrawal. More than 1,000 people receive emergency room treatment each day in the U.S. for misused prescription opioids. Withdrawal symptoms from opioid addiction are particularly harsh, causing many patients to relapse.
Nearly 80 percent of heroin users previously abused prescription painkillers. They often turn to heroin or other street drugs when painkillers become too expensive. Prescription opioids contribute to more deaths than heroin and cocaine combined. Prescription painkiller abuse has a significant human and economic toll. For example, prescription opioid abuse costs about $25.6 billion in lost workplace productivity each year.
Attorney General Swanson said the report relies on a multitude of interviews and contributions from health care professionals, emergency room personnel, government officials, and victims of the opioid epidemic as well as an extensive review of other states’ responses to the epidemic. She added that while the recommendations alone will not solve the prescription opioid epidemic, they hopefully mark the beginning steps of proposals to strengthen Minnesota’s response to the epidemic.
Recommendations in the report (on pages 29-36) include the following:
- Prescription drug monitoring program. To curb painkiller abuse, Minnesota should require prescribers and dispensers to review a patient’s history in Minnesota’s prescription drug monitoring database before prescribing or dispensing controlled substances. At least eight states appear to require dispensers or prescribers to check the drug monitoring database before filling most controlled substance prescriptions and over 20 more require it to be checked in some circumstances. For example, next year the neighboring state of Wisconsin will require all practitioners and prescribers to review a patient’s history in the monitoring database before prescribing or dispensing a controlled substance. Research indicates that required use of a drug monitoring program is effective in reducing opioid prescriptions. The database should also be modified to reflect whether a prescriber has had restrictions placed on their prescribing authority by the DEA or a health licensing board.
- Continuing education. Opioid prescribers and dispensers should be required to take at least two hours of periodic continuing education that addresses pain management, substance abuse disorder, and evidence-based best practices for prescribing and dispensing prescription opioids. At least 10 states require health care professionals to receive periodic continuing medical education on controlled substance prescribing and pain management.
- Information for patients. When opioid prescriptions are filled, pharmacies should be required to provide concise, plain-language information developed by the Minnesota Board of Pharmacy on the risks of opioid abuse and the proper disposal of unused medications.
- Naloxone (e.g. Narcan). This is a potentially lifesaving drug that can reverse an overdose if quickly administered. But it requires a prescription. At least nine states have or are implementing statewide standing orders for naloxone in which a state public health official authorizes pharmacies to dispense naloxone without an individualized prescription. Minnesota public health officials should do the same and issue a statewide standing order for naloxone, which pharmacies should be required to honor. First responders should be required to carry naloxone, and the Legislature should consider funding sources to defray these costs for responders and low-income Minnesotans.
- Disposal of opioid painkillers. Each county law enforcement agency and most pharmacies should be required to maintain collection receptacles for controlled substance drug disposal. Patients often don’t know how to dispose of unused medication. Surveys indicate that more than one-half of the people who abuse prescription drugs get them for free from a family member.
- Prescription duration. Under current Minnesota law, a prescription for controlled substances is valid for one year. This time period should be shortened to 30 days to decrease the amount of time that a prescription drug can be diverted or abused.
- Medical Assistance prior authorizations. Buprenorphine (e.g. Suboxone) is a drug to treat opioid dependence and it mitigates the otherwise harsh effects of opioid withdrawal. Prior authorization requirements for any form of buprenorphine should be removed from the Medical Assistance program.
- Pill mills. In order to identify “pill mill” providers who irresponsibly prescribe opioid painkillers or fraudulently bill government programs for such prescriptions, state government agencies with a legitimate need should be able to access the prescription monitoring database. All prescribers—including those who get paid in cash or don’t accept Medical Assistance—should be required to participate in the Opioid Prescribing Improvement Program (OPIP) enacted in 2015 to evaluate opioid prescribing patterns. To aid in the detection and halting of “pill mills,” the OPIP program should be implemented as expeditiously as possible. To curb overprescribing, a number of states have imposed guidelines for the recommended length and/or strength of opioid prescriptions, and the State should give consideration as to the adoption of such guidelines.
- Drug Courts. The Legislature should be responsive to the judicial branch’s requests for resources to better address drug addiction within the criminal justice system, including the formation of drug courts, which have shown success. About two-thirds of Minnesota counties have a drug court or plan to establish one but about one-third of counties do not.
- Expand access to treatment, especially in rural areas. Drug treatment options should be expanded, especially in rural areas. Every dollar spent on substance abuse treatment saves $4 in health care costs and $7 in criminal justice costs. Of the 122 physicians in Minnesota that are authorized to prescribe buprenorphine to treat opioid dependency, two-thirds are located in the seven-county metropolitan area.
National Public Health Award Given for Opioid Report
The National Conference of State Legislatures has given its 2017 Notable Documents Award in the category of Public Health to a report issued last November by the Minnesota Attorney General’s Office entitled, Opioids: Preventing and Addressing Prescription Drug Abuse.