Connecticut and Vermont Join the Ranks of New England States Limiting Opioid Prescriptions; Congress Also Takes Steps to Address Epidemic
On May 10, 2016, Connecticut Governor Dannel Malloy signed legislation limiting most first-time opioid prescriptions to seven days (Pub. Act 16-43). The Vermont General Assembly passed a similar bill earlier this month, which will require the state’s Health Commissioner to adopt rules governing opioid prescribing. (Note: The Vermont law was passed during the final week of the legislative session; as of Wednesday May 18th, 2016, the bill has yet to reach Gov. Shumlin for his signature.) Additionally the U.S. Congress has also passed legislation that will create new grant opportunities for states to address opioid abuse.
With more flexibility for prescribers, than the laws passed recently in Massachusetts and Maine, Connecticut’s legislation affords exceptions for palliative care and cancer pain, and allows providers to prescribe in excess of the cap for acute pain based on professional judgment. Furthermore, Connecticut did not restrict the supply of opioids that could be prescribed for chronic pain.
The law builds on 2015 legislation (Pub. Act 15-198) that set requirements for using the state’s prescription drug monitoring program, authorized pharmacists to prescribe naloxone, and required health care providers to complete continuing education courses in pain management and prescribing controlled substances. New provisions include:
- Prescription Drug Monitoring Program: Prescribers can now authorize individuals other than licensed health care professionals to use the prescription drug monitoring program on their behalf.
- Administering Naloxone: The new law includes immunity provisions for any licensed health care provider administering naloxone to treat or prevent a drug overdose; previously, only health care professionals authorized to prescribe naloxone had such immunity. The law also requires each municipality in the state to ensure that emergency responders are equipped with naloxone and prohibits insurers from requiring prior authorization for opioid antagonists.
- Acupuncture: The law expands the settings in which certified individuals may practice auricular acupuncture to treat alcohol and drug abuse.
The law does not codify specific limitations on opioid prescriptions. However, the legislation does note that new regulations may include evidence-based limitations on the number of pills that can be prescribed, including a maximum number of pills prescribed following minor medical procedures. A new 35-member Controlled Substances and Pain Management Advisory Council—which replaces the state’s 29-member Unified Pain Management System Advisory Council—will consult with the state’s Health Commissioner in adopting the rules.
The bill includes a number of notable provisions that go beyond limiting access to opioids. Specifically:
- Naloxone Rescue Kits: The bill appropriates $182,000 for the purchase and distribution of naloxone rescue kits; $32,000 is earmarked for purchase and distribution to emergency medical service personnel.
- Prescription Drug Monitoring Program Requirements: Pharmacies and other dispensers must report dispensing any Schedule II-IV controlled substances within one business day. The law authorizes—but does not require—the Health Commissioner to require prescribers to query the system before writing an opioid prescription through rulemaking.
- Provider Training: The Health Commissioner must convene medical educators and other stakeholders to develop curriculum changes to ensure students and residents are trained in prescription drug abuse prevention.
- Continuing Education: Physicians, advance practice nurses, pharmacists, dentists, and optometrists who prescribe or dispense controlled substances must complete at least 2 hours of relevant continuing education each licensing period.
- Medicaid Acupuncture Pilot: The Department of Vermont Health Access must develop a pilot project offering acupuncture services to Medicaid-eligible residents with chronic pain.
- Telemedicine: Payers must reimburse both the local and remote facilities when substance use disorder treatment services are delivered using telemedicine, unless the providers at each site are employed by the same entity.
- Prescription Drug Disposal: The Department of Health must establish and maintain a program to provide the safe disposal of residents’ unused and unwanted prescription drugs.
- Pharmaceutical Manufacturer Fee: Vermont currently requires pharmaceutical manufacturers and labelers to pay a fee on the prescription drugs paid for by the Department of Vermont Health Access (including Medicaid and CHIP). This bill increases the fee from 0.5 percent of the previous year’s drug spending to 1.5 percent. A portion of the increased revenues will fund many of the provisions introduced in this law, including the drug disposal, Medicaid acupuncture pilot, and naloxone distribution programs.
Comprehensive Addiction and Recovery Act of 2016
On May 13, 2016, the U.S. House of Representatives passed an amended version of The Comprehensive Addiction and Recovery Act of 2016 (S. 524). The bi-partisan legislation, which passed the Senate in March, now moves to a conference committee to reconcile differences between the engrossed bills. The language passed by the Senate and House both address opioid addiction on several levels: through prevention measures, by expanding access to emergency intervention resources such as naloxone, and by shifting approaches to opioid addiction away from incarceration and towards treatment. Currently, specific provisions include:
- Expanding access to naloxone via co-prescribing by pharmacists (with opioids) and providing training and resources for first responders, such as law enforcement and emergency medical services.
- Establishing grant programs to increase prescribing of overdose reversal drugs, including three-year grants of up to $500,000 to support states in developing best practices, training materials for prescribers and dispensers, and public education materials. A second grant program would provide up to $200,000 of funding per grant year to qualified entities (such as federally qualified health centers, opioid treatment programs, and certain practitioners dispensing narcotic drugs) to increase access to naloxone.
- Studying the effects of Good Samaritan Laws in states that provide immunity for individuals who seek emergency care for themselves or a loved one experiencing an overdose
- Grants to establish or expand supportive programs for veterans, such as veteran treatment courts programs, peer-to-peer services, practices providing treatment and transitional services to veterans who have been incarcerated, and training programs to teach criminal justice, mental health, and substance abuse personnel how to identify and appropriately respond to incidents involving qualified veterans.
- Targeted support to improve state prescription drug monitoring programs, supportingplans to “apply the latest advances in health information technology in order to incorporate prescription drug monitoring program data directly into the workflow of prescribers and dispensers to ensure timely access to patients’ controlled prescription drug history.”