It’s no secret that state legislatures are under intense pressure to take action to battle the opioid addiction problems within their state. In Utah, thirty to forty people die each month from heroin or opioid overdoses. That’s more than the number of people who are killed in crashes on Utah roads. Over 3,600 Utahns are being treated for heroin or opioid addiction in public programs, and according to Brent Kelsey, the assistant director of the Utah Division of Substance Abuse and Mental Health, “it’s a very significant problem.”
Due to the significant toll heroin and opioid overdoses take on Utah (overdose is the leading cause of injury death), the legislature of Utah has issued a working “evolving document” entitled, “Opioid Misuse: Options for Prevention, Identification, and Treatment.” The document explores different action items various stakeholders can do to help “do their part” in combating this epidemic.
Pharmaceutical Manufacturers
The legislature suggests that pharmaceutical manufacturers work to improve prescriber education (something we have long advocated for) and to increase the production of abuse-deterrent opioids, such as extended-release and long-acting.
Prescribers
The Utah Legislature places many of the solutions on the shoulders of prescribers, listing at least seventeen possible actions. The list of actions includes many suggestions we have heard before, including through hearings on Capitol Hill. Ideas such as: engaging in continuing professional education about opioid prescribing; comply with opioid prescribing guidelines (Utah Department of Health 2009 Guidelines and U.S. Centers for Disease Control and Prevention 2015 Guidelines); improve patient education; engage in peer review of prescribing practices; abide by prescribing limits; use pain medication treatment plans; and obtain continuing professional education on alternatives to opioids.
Dispensers
The Utah legislature suggest that dispensers take some actions as well, including: increase their use of the controlled substance database (ensure that they are checking all nonresidents, cash transactions, and all out-of-state prescriptions); that they integrate the use of the controlled substance database into their pharmacy workflow, following the example of Kroger, where nearly 100% of controlled substance prescriptions are checked; require identification of those who are picking up prescriptions; and allow partial fills so that only the amount requested by a patient is dispensed, up to the amount prescribed; among other ideas.
Insurers
Insurers were also given some tips and ideas on how they can work to combat the opioid epidemic, including: educate their insureds; cover abuse-deterrent opioids; cover the broad spectrum of treatment services, including medication-assisted treatment; use a patient review and restriction program to limit an at-risk patient to a single prescriber and a single pharmacy or pharmacy chain; and limit initial quantities prescribed.
Patients
We have heard from several sources, including patients themselves, that patients should have some responsibility in the opioid epidemic as it currently stands, and therefore, some responsibility in helping to combat it. Some suggestions put forth in the document by the Utah legislature included: securely storing their medications; obtain and act on education given by prescribers, dispensers, public service campaigns, etc.; develop realistic expectations about pain management; and complete periodic education and counseling during treatment of chronic pain.
State
The State had the longest list of potential solutions, divided into two parts: a Prescription Drug Monitoring Program and “Other.”
Prescription Drug Monitoring Program (PDMP)
The Utah legislature recommended a PDMP with many different facets, including the use of the controlled substance database. They also recommended that DPOL notify prescribers: of patient overdose, poisoning, and drug related DUI; of patients meeting criteria established by prescriber; and with suspect prescribing patterns. They also suggest that DOPL notify patient-designated third parties when a controlled substance is dispensed to a patient. Other suggestions follow actions taken by other states, including mandating use for patients meeting certain criteria (following in the footsteps of Kentucky, Tennessee, and New York) and notifying third-party payers (following Kentucky). The Utah legislature also suggested using tips from “Prescription Drug Monitoring Programs: An Assessment of the Evidence for Best Practices,” from Brandeis University.
Other
There were a slew of other suggestions offered by the Utah legislature on what states can do to help combat the epidemic, including: improve the availability of behavioral health treatment services for the incarcerated population; promote the availability of “on-demand” treatment (as Baltimore did); regulate pain clinics; leverage the Workers’ Compensation system to identify and treat misuse; increase the funding for treatment; leverage drug courts; and use a public health model to address the misuse epidemic.
Conclusion
While some stakeholders may be participating in some of, none of, or other, ideas, it is beneficial to know what ideas are out there. It is always helpful to be ahead of the curve when it comes to having an idea of the solutions that are being discussed, so we have an idea of possible further regulations we may be bound by.