Rising concern about opioid abuse has led to new state and federal regulations that affect the delivery of patient care nationwide.
Ken Whittemore, M.B.A., senior vice president for professional and regulatory affairs at Surescripts, discusses online prescriptions during the AAFP State Legislative Conference.
Prescription drug experts at the AAFP State Legislative Conference held here Oct. 27-29 discussed specific moves Congress and the states are taking to address the issue of opioid abuse.
On the national level, Congress this year passed the Comprehensive Addiction and Recovery Act (CARA), which increased to 275 the maximum number of patients for whom a physician can provide medication-assisted treatment (MAT) for opioid dependence. In a provision aimed at controlling usage and reducing diversion, the law allows prescribers or patients to request partial prescription refills and then opt to have the remainder filled within 30 days.
But despite legislators' urgency to pass the bill, lack of funding may limit its impact.
"Congress has been patting itself on the back for passing CARA, but we haven't seen any dollars appropriated for it," said Susan Awad, M.A., advocacy director for the American Society of Addiction Medicine.
- Prescription drug experts at the AAFP's 2016 State Legislative Conference discussed specific moves Congress and the states are taking to address the issue of opioid abuse.
- Congress passed the Comprehensive Addiction and Recovery Act, which increased to 275 the maximum number of patients for whom a physician can provide medication-assisted treatment for opioid dependence.
- Forty-seven states and the District of Columbia have laws in place to protect individuals who prescribe or dispense naloxone, most of them passed within the past five years.
And several states are hesitant to promote MAT because of the potential that drugs used for this purpose could be diverted, Awad noted.
Awad outlined progress against opioid abuse at the state level. She noted that 37 states and the District of Columbia have enacted laws(www.ncsl.org) that give individuals some legal immunity for calling 911 or otherwise seeking medical attention for themselves or someone else who is experiencing an opioid-related overdose. In addition, 47 states and the District of Columbia have laws to protect individuals who prescribe or dispense naloxone, most of them passed within the past five years.
Cara Christ, M.D., M.S., director of the Arizona Department of Health Services, noted that some communities have erected barriers to distributing naloxone despite the need for wider distribution channels. Her state's status as containing multiple mental health Health Professional Shortage Areas means there are too few qualified professionals who can provide MAT for patients, she said.
Five states have passed laws or regulations that place limits on prescription quantity. Connecticut and Massachusetts, for example, imposed a seven-day supply limit on new opioid prescriptions for adults and on all opioid prescriptions for minors. Exceptions are made for cancer, and chronic and palliative care.
Twenty-three states require prescribers and dispensers to use a state prescription database, and 18 states mandate some form of continuing education for prescribers.
Public expectations that new laws and regulations will quickly provide solutions to the problem of opioid abuse are high, but change occurs slowly. For instance, noted Ken Whittemore, M.B.A., senior vice president for professional and regulatory affairs at Surescripts, online prescribing was discussed as early as 1998 but was not permitted until 2010. Only 19 states permitted online prescriptions that year; all states did by 2015.
Within the past 30 days, 63 percent of all prescribers in the United States sent an e-prescription, according to Whittemore.
Overdose deaths are increasing, particularly in Southwestern states. The annual number of deaths in Arizona that are attributed to drug overdose increased from 1,052 in 2010 to 1,199 in 2015 after dropping in 2011 and 2012. In response, the state has applied for CDC grants and plans to implement a home visit program for at-risk families.
From 2005 to 2015, the number of deaths in Arizona caused by opioid pain relievers far outstripped those attributed to other drugs. In 2015, 405 deaths were caused by pharmaceutical opioid overdose compared with 237 heroin-related deaths.
"Seventy-five percent of heroin users started along the path of drug use with prescription medication," Christ said.
Awad encouraged physicians to get more involved with the issue.
"If you are looking for joy, consider adding addiction medicine to your practice," Awad said. "The reward is getting to see the patient make a full recovery."
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