Supporting Key Legislative and Policy Changes

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Return to Opioid Top-Level Strategy Map or the Zoom Map - Expand Harm Reduction Practices Associated with Opioid Misuse

State Policy Guide

The National Center on Addiction and Substance Abuse produced aPractical Guide for State Policymakers that was released in October of 2017

  Addiction Policy Forum released a report on Policy Responses to Addiction

 

General Information

A policy can allow doctors to hold patients who show signs of opioid misuse. This was proposed, but not passed in Massachusetts[1]

  In June 2016, the American Medical Association (AMA) held its annual conference and discussed ways in which healthcare professionals could address the opioid epidemic. The AMA's new president, Dr. Andrew Gurman, acknowledged that physicians have played a key role in creating the opioid epidemic. The AMA House of Delegates called for measures that would oppose barriers that can limit patient access to evidence-based, non-opioid and non-pharmaceutical therapies. In addition, they also called for having pain removed as a vital sign in professional standards, and to disconnect patient satisfaction scores from questions related to evaluation and management of pain in order to minimize prescribing opioids. The AMA also discussed increasing access to Naloxone, a drug that can counter the effect of an opioid overdose. In order to increase access to Naloxone, they called for public and private payers to include the drug on their preferred drug lists and formularies with little to no cost-sharing, liability protections for healthcare professionals who administer, prescribe, or dispense the drug, and to make the drug available at all pharmacies, at community-based organizations, correctional settings, schools, and law enforcement agencies.[2]

  There are contrasting reports on the effectiveness of policies on opioid prescribing and opioid and heroin overdose rates. In June 2016, UC Irvine Health reported that between 2006 and 2012, states enacted 81 laws to control use of powerful opioids such as Oxycontin and Vicodin. But even with these new prescription-drug monitoring programs and other regulations, researchers at Dartmouth Institute for Health Policy and Clinical Practice found that 45% of disabled Medicare beneficiaries were still using opioids in 2012. The same study found no discernible difference in opioid use or overdose as a result of tighter regulations. [3] In contrast, a study published in the October 2016 issue of Health Affairs reported that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent form 2006-2013.[4]

  In their 2015 report, the National Heroin Task Force stated that policies regarding opioid and heroin use must be grounded in scientific understanding that substance use disorders are a chronic brain disease that can be prevented and treated, leading to recovery.[5]

 

Promising Legislation

Laws that give police, first responders, or family members, the ability to carry and administer naloxone (Narcan).

  Good Samaritan Laws provides immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose.[6] The Policy Surveillance Program provides an interactive database of current Good Samaritan Laws in the U.S. As of July 2016, 35 states and Washington D.C. had Good Samaritan Laws in place.[7]
 

 

Federal Bills

S. 1455 - The Recovery Enhancement for Addiction Treatment (TREAT) Act: Bipartisan legislation introduced by U.S. Senators Edward Markey and Rand Paul on May 22, 2015, this bill will expand treatment for those suffering from prescription drug and heroin addiction. A companion bill was introduced in the House of Representatives by Brian Higgins, Richard Hanna, Paul Tonko, and John Katko. The legislation would expand the ability of addiction medical specialists and other trained medical professionals to provide life-saving medication-assisted therapies such as buprenorphine for patients battling opiate addiction. The bill will raise the limits on the number of patients a physician or nurse practitioner may treat from 30 to 100 in the first year and with no limit thereafter. Those providing treatment must receive additional training in addiction, use the Prescription Drug Monitoring Program (PDMP) and administer treatment in a qualified practice setting with defined oversight.

S. 954 - The FDA Accountability Act: Bipartisan legislation introduced by Senator Joe Manchin on April 15, 2015. Co-sponsors include Tim Kaine, David Vitter, and Shelley Moore Capito. The bill requires the FDA to establish an advisory panel for each application submitted to the FDA for approval of an opioid drug and report to congress on any instance where approval is recommended when inconsistent with the advice of the panel. A drug approved inconsistent with the recommendations of the advisory panel shall not be introduced or delivered for introduction into interstate commerce until the report describing the approval has been submitted to Congress.

S. 1913 - The Stopping Medication Abuse and Protecting Seniors Act: Bipartisan legislation introduced on July 30, 2015, by Senator Pat Toomey with co-sponsors Joe Manchin, Tim Kaine, Sherrod Brown, Rob Portman. This bill would authorize the use of patient review and restriction (PRR) programs in Medicare, which can help prevent prescription drug abuse among beneficiaries. The use of PRR programs will assign patients who are at-risk for opioid dependence to predesignated pharmacies and prescribers to better manage appropriate care and monitor prescriptions of opioid drugs for Medicare beneficiaries.

S. 524 - 2015 Comprehensive Addiction Recovery Act: This legislation was re-introduced on February 15, 2015, by U.S. Senators Sheldon Whitehouse and Rob Portman and was co-sponsored by 13 additional Senators. A House of Representatives companion bill, HR 953 has also been introduced. This legislation will expand prevention and education efforts, expand access to the overdose-reversing drug Naloxone, support alternative treatment in lieu of incarceration, strengthen the Prescription Drug Monitoring Program and support expansion of the use of evidence-based treatment medications. CARA 2015 designates up to $80 million toward these efforts. This Bill became law in the summer of 2016.

S. 799 - The Protecting our Infants Act: Bipartisan legislation introduced on March 19, 2015, by Senator Mitch McConnell and Casey with co-sponsors Kelley Ayotte, Rob Portman and others. Companion bill introduced in the House by Representative Clark with 72 co-sponsors. This bill requires the Agency for Healthcare Research and Quality to report on prenatal opioid abuse and neonatal abstinence syndrome (symptoms of withdrawal in a newborn). The report must include an assessment of existing research on neonatal abstinence syndrome, an evaluation of the causes, and barriers to treatment, an evaluation of treatment for pregnant women with opioids use disorders and infants with neonatal abstinence syndrome, and recommendations on preventing, identifying, and treating opioid dependency in women and neonatal abstinence syndrome. HHS is directed to develop a strategy to address gaps in research and programs and the CDC must provide technical assistance to states to improve neonatal abstinence syndrome surveillance and make surveillance data publicly available. This Bill became law on November 25th 2015.
 

Examples of State Legislation

California (Alameda County)

  • Local ordinances that require drug manufacturers to establish and fund a drug disposal program.[8]
  • California legislation has is in process for reducing treatment fraud and waste: [1]

Connecticut

  • Statute enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.[9]

Illinois

  • Statue enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.[10]

Kentucky

  • Board rules required by statute enacted September 2012: 48 hour limit on dispensing Schedule II and III controlled substances by physicians. No limit on opioid prescriptions.[11]

Massachusetts

North Carolina

  • Statute enacted January 1, 2017: The Strengthen Opioid Misuse Prevention (STOP) Act of 2017, or STOP Act, is intended to reduce the supply of unused, misused and diverted opioids circulating in NC, reduce “doctor shopping” and improve care by requiring prescribers to use tools and resources that help prevent inappropriate prescribing. NCMB supported passage of the STOP Act.
    • Limits on the number of days worth of opioids that may be lawfully prescribed upon initial consultation for acute injuries (no more than a five day supply allowed) and following surgeries (no more than a seven day supply allowed). The STOP Act does NOT limit the amount of opioids that may be prescribed to a chronic pain patient;
    • A requirement that prescribers use the NC Controlled Substances Reporting System (NCCSRS), the prescription database that records all controlled substance prescriptions dispensed in outpatient pharmacies across NC. The STOP Act requires prescribers to review the patient’s 12-month history with the NCCSRS before issuing an initial prescription for a Schedule II or Schedule III opioid, and subsequent reviews every three months thereafter, for as long as the patient continues on the drug;
    • A requirement that PAs and NPs practicing at pain clinics consult with their supervising physicians prior to prescribing opioids. NOTE: The Board has not determined how it will define “consult”. The most important thing is that a meaningful consultation about the patient and recommended treatment occurs and is documented in the medical record; the Board may ultimately leave it up to PAs, NPs and their supervisors to determine exactly how consultations occur, consistent with its current approach towards physician supervision of PAs and NPs.[13]

Washington

  • Guidelines and board rules required by statute. Guidelines revised June 2015, board rules implemented between July 2011 and January 2012, and statute enacted January 2010: Pain specialist consultation required prior to prescribing daily morphine equivalent doses of 120mg or greater (with exceptions).[14]
  • Law Enforcement Assisted Diversion

Rhode Island

New Jersey


National Association of Counties
 

Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis


Grant Waivers to all 50 States for the IMD Exclusion
[2]
 

  • Mandate Prescriber Education
  • Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
  • Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
  • Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
  • Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions; we must equip all law enforcement in the United States with naloxone to save lives
  • Develop and disseminate Fentanyl detection sensors
  • Support and fund interstate sharing of PDMP data
  • Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
  • Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses verses physical health diagnoses

 

Federal Legislation

  • Affordable Care Act (2010) - More than 20 million people received support to get mental health and substance abuse treatment through the 2010 ACA.[15] If it is repealed and its replacement does not offer the same coverage many people will be unable to get to access treatment for addiction. The New York Time's Editorial Board states that "repealing the health care law is likely to exacerbate the crisis."[16]

 

Sample Protocol for State Law Adoption

Illinois SB2928 is a current law with the common name "Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. [17][18] It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. [19] The lead Project Coordinator Bill Gentes has as a result been awarded CADCA's Advocate of the Year.[20] The following steps were used in the creation, adoption and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

  1. Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one review current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
  2. Partnering with Local Law Enforcement - As stated by Gentes at an interview "“circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process."[21] In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more. [22]
  3. Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference....'look, you guys dropped off 500 pounds and I want to tell you want that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process.'"[23]
  4. Securing Public-Private Partnerships - Walgreens has been approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be issue with a need to review current laws regarding drug disposal. [24] This has as a result increased the capacity of the project and accompanying police force in collection efforts.
  5. Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support. [25]
  6. Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments. [26][27]

 

Lobbying Legally

501(c)3 organizations (tax-exempt non-profits) have some restrictions on lobbying in the government. This guide explains federal laws on non-profit lobbying for policy changes.
 LegalLobbying.PNG[28]
 

Key Lobbying Rules

  • The IRS defines direct lobbying as: "A direct lobbying communication is any attempt to influence any legislation through communication with:Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation."
    • Direct Lobbying Communication is defined as: "Referring to specific legislation and reflects a view on such legislation"
  • The IRS defines grassroots lobbying as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof"
    • Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation"


Lobbying that falls under either the grassroots or direct lobbying definition is restricted, but not prohibited. See Tools & Resources.
 

Key Lobbying Groups

FedUp!

  • A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids
  • FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies


To learn more go to: [3]

Tools & Resources

TR - Adopt Key Legislative & Policy Changes to Address the Opioid Crisis

Scorecard Building

Potential Objective Details(Under construction) 
Potential Measures and Data Sources(Under construction) 
Potential Actions and Partners(Under construction) 

Resources to Investigate

RTI - Adopt Key Legislative & Policy Changes

PAGE MANAGER: [insert name here]
SUBJECT MATTER EXPERT: [fill out table below]

Reviewer Date Comments
     

Sources

  1. [4]
  2. [5]
  3. [6]
  4. [7]
  5. [8]
  6. [9]
  7. [10]
  8. Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016
  9. [11]
  10. [12]
  11. [13]
  12. [14]
  13. [16]
  14. [17]
  15. [18]
  16. [19]
  17. [20]
  18. [21]
  19. [22]
  20. [23]
  21. [24]
  22. [25]
  23. [26]
  24. [27]
  25. [28]
  26. [29]
  27. [30]
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